Claims Oversight

Increased Earnings Through Risk Management

Healthcare Risk Management Group (HCRMG) focuses on protecting our client’s assets while optimizing the use of their premium dollars. We provide superior claims & risk management consulting tailored to the unique exposures of each client. Our experienced claims oversight staff works diligently to eliminate our clients’ exposures, reduce their costs, and optimize their efficiency while improving our clients’ Profit & Loss Statement.


  • Streamlining the claims process – We understand the time sensitive nature and economic impact of the claims process. Which is why we work directly with our carrier partners to ensure the claims process is as fluent and cost efficient as possible for our clients.
  • Exceptional Underwriting & Claims Review – Our distinguished underwriting personnel utilize their experience and expertise to review and reassess each loss incurred by our clients. We do so in an effort to close each claim as quickly as possible and implement any reduction(s) available where applicable to achieve the most beneficial impact on our client’s Experience Modification Factor.
  • Providing Award Winning Worker’s Compensation Consulting & Comprehensive Coverage – Working with Management to train personnel on the claims process and forms, educate them on the applicable law, and implementing a Return-to-Work program.
  • Up-To-Date Claim Status Reporting – Communication with our clients is of the utmost importance at Healthcare Risk Management Group, keeping our clients in “the loop” every step of the way during the claims process. We pride ourselves in treating our client’s assets as if they were our own, doing everything in our power to protect their assets from inherent exposures in a cost efficient manner.


Strategic Planning

All risks are NOT the same

Every company, employer and organization has their own unique business model and structure that must and assessed & analyzed when evaluating the risks of each entity. Our professionals at HCRMG will begin every client engagement by first understanding the client’s organization and designing a strategic risk management plan tailored to the client’s needs and exposures. When designing these strategic risk management plans for our clients, we take into account factors such as actuarial projections, long & short term financial goals, cash flow, exposures to risk, management structure and tax strategies.


What separates us from the competition are the various managerial & administrative services we implement in an effort to provide our clients with the most comprehensive risk management program possible. We provide a thorough initial evaluation, outstanding project management and top-notch excess and reinsurance placements.


We treat your organization as if it were our owns, employing one of the following four approaches:


  • Traditional Insurance: For many organizations, traditional insurance is the only practical option. We've worked with major insurers to develop especially attractive traditional insurance programs that provide many of the advantages of non-traditional risk finance to clients that are not large enough for these alternatives.
  • Self-Insurance: These programs achieve lower cost, but often require state approval and strong management discipline. We've managed some of the largest and most successful self-insurance programs in the country.
  • Government Risk Pools: Most states allow governmental entities to create self-insurance pools. This approach is particularly cost effective. We manage more governmental risk pools than any other program administrator in the country.
  • Captive Insurance Companies: Non-governmental organizations that want the benefits of a risk pool can do so through a captive insurance company. Whatever the size of the group, captives create efficiencies for organizations that are committed to safety.


Safety & Loss Control

Preventative Measures are a vital aspect of any successful Loss Control Program

The best way to mitigate and control losses incurred from claims is to implement the correct procedures, protocols, and programs to prevent claims from occurring in the first place. Healthcare Risk Management Group (HCRMG) understands that not all claims can be prevented or avoided, however, the experienced loss control professionals and safety consultants of HCRMG are here to help our clients whenever those “unforeseen” claims occur.


HCRMG gladly offers our “Safety & Loss Control” solutions as a standalone service, or incorporates it as part of a client’s relationship with HCRMG. Your HCRMG program will be designed to;


  • Meet your individual needs – with a choice of training programs and services, from accident investigation to infrared inspections.
  • Reduce employee injuries and create a safer, more responsible work environment for your employees. Resulting in a savings on your workers’ compensation expense through a reduction in the number of employee related incidents.
  • Compliance with all local, state and Federal mandates, including but not limited to JCAHO, DOT, OSHA and EPA guidelines.
  • Utilize our experienced staff’s knowledge & expertise from a wide array of industries, including Healthcare, hospitals, Home Healthcare, Assisted Living Facilities, transportation safety, public utility and nursing.


Audit Consulting

Experience You Can Rely On

When it comes to conducting an effective audit, experience of the assigned auditor makes all the difference. Healthcare Risk Management Group provides our clients around the clock access to our seasoned and distinguished audit consultants. Our audit consultants provide our clients with a wealth of knowledge & service in a multitude of disciplines, jurisdictions and industries. The Services offered include, but are not limited to;


  • Arbitration, Litigation and Mediation Support
  • Expert Witness Testimony & Opinions
  • Payroll Audit Services
  • Best Practices Analysis
  • Reserve Studies
  • Commutation File Inspection & Negotiation
  • Accompanied by operational reviews
  • Due Diligence Audits
  • Retrospective Premium Audits


Statutory Compliance

Code Rule 59: “The Workplace Safety and Loss Prevention Program” was created in 1996 as part of the Regulatory Reform Legislation. It requires that an employer undergo a comprehensive safety and loss prevention consultation if they have generated an experience modification rating higher than 1.20 and payroll over $800,000. The objective of this Program is to help reduce workplace injuries to employees covered under the Workers’ Compensation system in New York State. A company or employer who meets the criteria for this program will receive a Notice from the New York Compensation Insurance Rating Board. Here are the steps to follow upon receipt:


  1. Select a consultant within 30 days of receipt of original notice. A list of consultants can be located at the Department of Labor website. Use the consultant database search engine to locate one in your area.
  2. Notify the Department of Labor and your Workers’ Compensation insurance carrier, in writing, of consultant choice within 10 days of making your selection.
  3. The evaluation must be completed by the consultant and the findings reported to the employer within 75 days from date of original notice.
  4. You must submit your remediation plan to the Department of Labor and the carrier within 30 days of receiving the consultant report.
  5. The remediation plan must be implemented within 6 months of the employer’s receipt of the evaluation.
  6. The consultant will follow up to see that recommendations have been implemented within 60 days after the maximum six months allotted to complete action items.
  7. The consultant will, within 45 days of inspection, report findings to DOL and the employer.


The HealthCare Risk Management Group (HCRMG) strongly believes the utilization of technology & the analysis of data are essential to our ability to provide a better product, experience and relationship to our clients. This is why HCRMG provides its clients with industry specific web portals designed to aid in the implementation of the recommendations set forth in the consultant report, which include;


  • Complete Safety Plans which can be downloaded, edited and modified to fit your specific needs
  • Remediation plan templates
  • Training resources and forms
  • Policy and Program models
  • Safety Checklist
  • Safety Violation Policy
  • Inspections Checklist
  • Safety Rules


For further information regarding the Code Rule 59 Program please contact the HealthCare Risk Management Group today. We have the necessary resources available to teach you how to lower your Experience Modification Factor and control your Workers’ Compensation costs.