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Our Services

Our Services

  • Certified Claim Adjudication Services

  • Medical Case Management

  • Monitoring Medical Progress

  • Authorization & Denials of Medical Treatment

  • Medical Bill Review, Re-Pricing and Payment

  • Early Return to Work Programs

  • Vocational Services

  • Permanent Partial Disability /Pensions / Second Injury Fund

  • Medicare Liens, Set-Asides & Structured Settlements

  • Litigation

  • Private Investigation

  • Compliance, Reporting & Data Analytics

Certified Claim Adjudication Services

SCC Risk 360 reviews, investigates, and adjudicates all new loss information.  Careful consideration is given to complex claim validity issues and the application of timely filing requirements.

When an employee is totally temporarily disabled or when an employee’s earning capacity has decreased because of his/her industrial injury or occupational disease, the employee may be eligible for Time-Loss Indemnity or Loss of Earning Power Benefits.  SCC Risk 360 will accurately calculate the employee’s pre-injury wages and make timely indemnity payments to the employee.  This includes determining dependents, reporting to the Department of Labor and Industries, constructing statements of benefits, and issuing underpayments/overpayments as necessary.  SCC Risk 360 is committed to making indemnity payments as close to the employee’s regular payroll schedule as possible to prevent financial hardships.

Realistic claim reserves for all anticipated benefits and related cost exposures on each claim are established and maintained by SCC Risk 360.

Medical Case Management

Monitoring Medical Progress

SCC Risk 360 claim administrators work closely with each claimant’s attending

physician.  Their extensive training and professional experience allows them to efficiently monitor medical progress (SOAPER chart notes) including subjective symptoms, objective findings, imaging results, curative treatment plans, and more.  Our claim administrators coordinate referrals to surgeons, therapists, concurrent care providers, specialists, and order Independent Medical Examinations (IME) whenever necessary.  They also obtain and review each claimant’s Activity Prescription Form (APF) for updated physical restrictions after each visit with his/her attending physician to address their ability to work.

Our medical case management efforts are known to increase long-term objective medical improvement, prevent prolonged claims, and reduce medical/pharmacy bills.

Authorization & Denial of Medical Treatment

SCC Risk 360 has extensive experience in making complex medical treatment decisions.

Our claim administrators and contracted nurse case managers review medical progress, recommended treatment plans, objective medical findings, and the causal relationship of newly contended conditions industrial injury/occupational exposure.  This information is used for utilization review of ongoing conservative treatment (such as physical therapy) and the need for specialty consultations, diagnostic imaging/tests, surgeries, and more.  Our team ensures the treatment being provided is medically appropriate for allowed conditions.

Medical Bill Review, Re-Pricing, and Payment

SCC Risk 360 provides all necessary bill review services ensuring reasonableness, causal relationship to the accepted conditions, conformity to the appropriate fee schedule, and/or established PPO agreements and utilization guidelines.

SCC Risk 360:

  1. Reviews all bills promptly for compliance with applicable fee schedules and reduce or discount accordingly
  2. Prepares all documentation necessary for the payment of authorized medical expenses will be prepared in compliance with the current State medical fee schedule (MARFS)
  3. Identifies and reduces all duplicate billings
  4. Denies charges for all items not required for the accepted conditions
  5. Identifies all unauthorized charges to ensure billing does not exceed parameters of injured worker’s treatment plan
  6. Handles all provider inquiries regarding bill reductions
  7. Ensures all bill reviews, payments with adjustment advice, notices of rejection and/or denial of liability are issued within mandated timeframes
  8. Provides a summary of savings/discounts achieved on behalf of our clients.
  9. Provides access to a medical network with an outcomes focus
  10. Provides access to a pharmacy management program that includes opioid overview
  11. Provides access to a physical therapy network(s) for prospective and retrospective review.

Early Return to Work Program

SCC Risk 360 prioritizes proactive Early Return to Work Program development and implementation.  Our goal is to bring injured workers back immediately after their first medical visit, or as soon as possible thereafter.  Our strategies mitigate unnecessary time-loss indemnity risk and keep injured workers focused on their ABILITIES- rather than their disabilities.  Our claim administrators have extensive experience coordinating return to work efforts between our the injured worker, his/her attending physician, and vocational rehabilitation counselors (if one is assigned to the claim).

Research shows that workers who remain engaged in the workforce while recovering from an industrial injury or occupational disease have improved medical, vocational, and mental health outcomes.  Employees who return to meaningful light duty within the first 15-30 days following an industrial injury have a 70% higher probability of returning to their job of injury at [or long before] claim resolution.  Early Return to Work efforts are proven to prevent time-loss indemnity, retraining, pensions, and other risk.

SCC Risk 360 will construct a bank of Certified Job Analysis (JA) for each position at your business.  If one has already been constructed, we will review each job analysis for accuracy and re-certify them on an annual basis, as required by Washington State Law.  Our TPA’s have created JA banks for employers of all sizes and industry types; this experience will bring your business innovative ideas for meaningful light and modified duty positions.

We specialize in meeting the Early Return to Work needs of non-profit agencies, municipalities, business entities with unionized employees and complex collective bargaining agreements, specialized trades, and other jobs with strenuous physical demands.

Vocational Services

SCC Risk 360’s vocational services include but are not limited to:

  • Disability Management
  • Return to Work Intervention
  • Employer Consultation
  • Administrative Service Contracting
  • Job Modifications/Accommodations
  • Ergonomic Assessments
  • Medical Case Management
  • Employment Retention
  • Training Plan Development
  • Job Analysis Construction & Annual Recertification
  • Vocational Data Services
  • Catastrophic Nurse Case Management

Permanent Partial Disability / Pensions

An injured worker may reach “Maximum Medical Improvement,” but still have a Permanent Partial Disability (PPD) or Permanent Total Disability. This may include any impairment of physical or mental function that detracts from the worker’s physical or mental efficiency and thus hinders the worker in the ordinary pursuits of life.  We strive to accommodate disabilities and return injured workers to meaningful employment; however, these extenuating circumstances may be unavoidable.

SCC Risk 360 specializes in calculating and administrating the payment of PPD awards and pensions based on medical opinion and applicable state guidelines/laws.  Our goal is to make the process as painless as possible!

Medicare Liens, Set-Asides, & Structured Settlements

SCC Risk 360 has systems and controls that provide all claim reporting required under Section 111 by and to Medicare. We assume responsibility for the creation and proper submission (upload and download) of files using an acceptable format as a file transfer method for Section 111 files. We review the file functions of the reporting agent and assist  with MMSEA Section 111, as needed, to ensure compliance with reporting requirements.

SCC Risk 360 provides a list of preferred MSA providers to its clients.  We also extend our clients with the flexibility of selecting a non-preferred MSA provider, should it be deemed appropriate on either an individual case-by-case or program-wide basis.

Litigation

SCC Risk 360 has systems and controls that provide all claim reporting required under Section 111 by and to Medicare. We assume responsibility for the creation and proper submission (upload and download) of files using an acceptable format as a file transfer method for Section 111 files. We review the file functions of the reporting agent and assist  with MMSEA Section 111, as needed, to ensure compliance with reporting requirements.

SCC Risk 360 provides a list of preferred MSA providers to its clients.  We also extend our clients with the flexibility of selecting a non-preferred MSA provider, should it be deemed appropriate on either an individual case-by-case or program-wide basis.

Legal Services:

  • Department of Labor & Industries (LNI): Protest & Misdirected Appeal Representation
  • Board of Industrial Insurance Appeals (BIIA): Mediation Representation
  • Board of Industrial Insurance Appeals (BIIA): Appeal Hearing Representation
  • Board of Industrial Insurance Appeals (BIIA): Petitions for Review
  • Superior Court Representation
  • Third-Party Claim Liability Settlement Negotiations
  • Safety Inspection & Citation Representation
  • Workplace Rights Audit & Citation Representation

SCC Risk 360 pursues third-party claim liability on behalf of self-insured employers.  All subrogation possibilities will be identified and investigated for potential recovery, including investigation, evaluation, and negotiation of subrogation cases.  We assist, as needed, in recovery and the distribution of any recovered sums.

Private Investigation

SCC Risk 360 is a Licensed Private Investigation Agency.  If fraud is suspected or a worker is engaging in activities outside of their limited physical capacities during their personal time, we conduct surveillance.  Our investigators may also collect pertinent claim evidence including witness statements, legal declarations, pictures, text messages, security camera footage, and more.

Safety Consultations and Citations

Need to prepare for your transition to self-insurance?  Our safety & compliance experts have you covered!

Safety Services (OSHA, WISHA, DOSH):

  • Onsite Safety & Health Consultations
  • Self-Insurance Certification Preparation
  • Personal Protective Equipment (PPE) Recommendations
  • Accident Prevention Program (APP) Assistance
  • Hazard Communication Program Assistance
  • DOSH Audit & Inspection Representation
  • DOSH Citation Mitigation & Appeals
  • Abatement Assistance
  • Safety Training/Safety Ambassador Program

OSHA

OSHA Services:

  • Four System Approach to Incident Investigations
  • Root Cause Analysis for Safety Improvement
  • Injury Reporting
  • Tracking of Days Away from Work
  • Completion of OSHA Forms: 300, 300A, 301

Workplace Rights, Audits, and Citations

Workplace rights are enforced by the Washington State Department of Labor and Industries, although there may be crossover with other local, state, and federal agencies. If there is any disagreement surrounding workplace rights, wages, leave, the duties/hours of minor employees, etc., benefit of the doubt is always given to the employee- never the employer. It is the employer’s burden to provide specific, objective key facts and evidence to disprove the current/former employee’s contention of violation. It’s important to dispute inaccurate information as it can result in fines, fees, and restitution payable to the employee.

We are Workplace Rights experts, so you don’t have to be! We handle the entire dispute process for our clients from start to finish [with great success]. We also assist with audits, citations, and administrate employer participation in a myriad of rebate programs.

Employment Security Department

When a job separation occurs, employees are highly likely to apply for unemployment benefits (regardless of eligibility) through the Washington State Employment Security Department. Shortly after the employee files, an adjudicator from the Department will collect information from your business to determine the reason for separation. Like L&I laws, if there is any disagreement surrounding the reason for separation and/or eligibility, benefit of the doubt is always given to the employee- never the employer. It is the employer’s burden to provide specific, objective key facts and evidence to disprove the former employee’s eligibility contention. It’s important to dispute inaccurate information as well as ineligible and fraudulent unemployment benefit claims as they cause your business’ ESD premiums to rise.

We are ESD claim administration experts, so you don’t have to be! We handle the entire dispute process for our clients from start to finish- with great success. We also assist with audits, citations, and administrate employer participation in a myriad of rebate programs.

Employment Security Department Services:

  • Reason for Separation Statements
  • Unemployment Benefit Claim Disputes & Hearings
  • Relief of Benefits Charge
  • Expanded Pandemic Unemployment Assistance
  • Paid Family Medical Leave (PFML)
  • Layoffs vs Furloughs
  • Worksource and H-2A Agricultural Program Assistance
  • The SharedWork Program Assistance
  • Trade Adjustment Assistance
  • Audit & Citation Representation
  • Worker Opportunity Tax Credit (WOTC) Assistance
  • Veteran Hiring Incentive Program Assistance
  • WA Cares Fund