Pennsylvania Third Party Administrator (TPA)

 

Gilbert’s Risk Solutions is an outsourced claims administration solution for Pennsylvania employers that self-insure their workers’ compensation program. Our Third Party Administration (TPA) relationship is licensed in the Commonwealth of Pennsylvania. It makes sense to outsource claims, both for the expertise and because it is prohibitively expensive for all but the largest employers to maintain an in-house claims operation.

Our Third Party Administration (TPA) relationship is licensed in the Commonwealth of Pennsylvania. It makes sense to outsource claims, both for the expertise and because it is prohibitively expensive for all but the largest employers to maintain an in-house claims operation.

 

Gilbert’s expert claims team can take the headache out of your workers’ compensation administration and help you to control your costs. We take a risk management, consultative approach to our services, partnering with you to identify and mitigate risks, employing best practices in claims administration, and working to the optimal resolution of every claim.

 

Workers’ comp claims are time sensitive, complex, and sometimes contentious. They require a three-way communication among the employer, the employee, and the treating physician. Today, average claim costs are 40% wage replacement and 60% medical costs. In addition to excellent claims administration, we have specialized expertise in managing the growing medical component of the claim.

 

While we’re proud to call Pennsylvania our home, we’ve helped businesses all across the country manage their risk and we look forward to helping you, too – no matter where it is that you call home.

Services provided by our TPA include:

 

  • Timely Benefits Administration and Check Issuance
  • Completion of Annual Accident/Illness Workers’ Comp Bureau Report
  • Actuarial Analysis
  • Pre-, During & Post-Injury Best Practices
  • Supervisor Training  
  • Loss Control & Safety
  • Claims Reporting Process & Intake
  • Pre-Claim Qualifications
  • Timely Accident Investigations
  • Determination of Work-Relatedness; Compensability
  • Denial of Non-Compensable Claims
  • 3 Point Communication
  • Fraud Surveillance
  • Scheduling of RN and Medial Management Services
  • Scheduling of IME
  • Medical Bill Repricing
  • Completion of 1099
  • Transitional Return-to-Work Planning
  • Recommendations of Settlements
  • Subrogation

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Our goal is to be your outsourced risk management partner

Business owners know that there’s always something that can go wrong.  Whether it’s a production delay due to a problem in the supply chain or a worker injury on the plant floor, you need to protect your operations, your productivity, and your bottom line. Gilbert’s Risk Solutions can help.

Our goal is timely claim management to optimal resolution

Hours and days can add up to huge costs in workers’ compensation claims. It’s essential to bring best practices and processes to bear on each and every claim, from claim reporting and transitional return to work through to timely claim resolution. We can help you to reduce losses and achieve the best possible outcomes for your employees and your bottom line.

Our Process

We take a risk management approach to claims management. First, we take the time to thoroughly understand your business and to learn about your business, your current processes and procedures, and your exposures. We recommend a plan to address any exposures and work with you to set goals and targets for improvement.

When a Claim Occurs

When a claim occurs we work aggressively to control your claim costs by establishing and maintaining communication with the employer, the injured employee, and the medical provider. We work professionally and objectively to advise all parties involved with the goal of creating a safer work environment and executing cost reduction strategies to ensure timely claims resolution.

Our Team

Our highly experienced team includes every discipline you need for a successful effort: claims management, risk management, loss control, data analysis, nurse case management, Human Resources, and more. We work closely with your internal risk manager, HR staff, and supervisors to implement best practices, roles, and responsibilities – all with the goal of to helping injured employees with timely return to work, reducing losses, and mitigating exposures.

Testimonials