Continuous Quality Improvement

Option injury benefit plans are continually innovating to ensure coverage for work-related injuries and improve medical outcomes.  Updates are also sometimes required for compliance with new statutes, regulations and case law.  National attention on Options to workers; compensation and completion of the first year of operations under the Oklahoma Option have also encouraged a re-examination of benefit plan coverage terms.  For example, the immediate injury reporting requirement has numerous advantages for injured workers, co-workers and employers, but this is one of the issues causing concern about Option programs.  For that reason, Texas and Oklahoma insurance companies and employers are confirming appropriate use of the "good cause" exception for immediate reporting.  They are also further considering ways to combine incentives to obtain care quickly with fairness to all parties, and how the "good cause" exception for immediate reporting.  They are also further considering ways to combine incentives to obtain care quickly with fairness to all parties, and how the "good cause' exception for immediate injury reporting can be extended to other medical management requirements.  Certain limitations on medical expenses that are unnecessary and have never been applied to a single claim can also be removed.  Benefit plan provisions supporting child support liens and ensuring the Option plan is the primary source of recovery for injured worker benefits may also need to be clarified in some programs.  Of course, Option insurance companies will also continue to compete based on breadth of coverage, as well as price.

More communication between employers and employees, and ERISA's fiduciary standards to act in the best interests of injured workers, are distinct advantages for Option programs over most workers' compensation programs.  Here's one more huge advantage when it comes to making updates like those described above:  They will not be delayed by the years often required to enact enabling legislation and regulations.  So, we expect to see Option injury benefit plan coverage to broaden for hundreds of thousands of injured workers in 2016.