MEC Connect

osts Matt Yehling and Patty Reinecke are joined by Marianne Reed, Senior Claims Analyst at MEC, to discuss strategies for containing and mitigating costs in complex workers compensation claims. Marianne shares her expertise on identifying cost drivers, collaborating with stakeholders, and implementing targeted interventions to improve outcomes and reduce expenses.Discussion Points:Cost Drivers in Complex Claims: Marianne outlines the medical treatments that tend to be the biggest cost drivers in complex claims, such as injections, brand name medications, spinal cord stimulators, and failed surgeries. She also describes the typical features of these claims, including multiple surgeries, psychological issues, and long-term opioid use. Strategies for Cost Containment: Marianne shares her approach to mitigating costs, which involves reviewing medical records, engaging MEC's resources, collaborating with stakeholders, and implementing targeted interventions like medication reviews and negotiated rates.Successful Claim Intervention Case Study: Marianne provides an example of a catastrophic claim where early intervention by MEC led to a successful outcome. 

Hosts Matt Yehling and Patty Reinecke sit down with Dr. Fernando Branco, MEC's Chief Medical Officer, to discuss Complex Regional Pain Syndrome (CRPS) and Reflex Sympathetic Dystrophy (RSD). Dr. Branco shares his expertise on these challenging diagnoses, explaining how they can develop from seemingly minor injuries and the difficulties in accurately diagnosing and treating these conditions.Discussion Points:Sprains and Strains Progressing to CRPS/RSD: Dr. Branco explains that it's common for minor injuries like sprains and strains to progress into CRPS or RSD, especially in the excess claims world. He notes that increased awareness of these conditions has also led to potential overdiagnosis. Diagnosing CRPS/RSD: Dr. Branco emphasizes the importance of a thorough physical exam and following established diagnostic criteria. He discusses the role of temperature measurements, sweat tests, bone scans, and sympathetic blocks in the diagnostic process.Treating CRPS/RSD: Dr. Branco outlines a treatment approach that includes sympathetic blocks, aggressive physical therapy with desensitization techniques, cognitive behavioral therapy, and medication management. He stresses the importance of an experienced, multidisciplinary team and cautions against overreliance on invasive treatments.

This episode features guest Tina D'Andrea discussing the critical topic of post-traumatic stress disorder (PTSD) in the workplace. With over 25 years of experience in workers compensation, Tina offers deep insights into the symptoms, diagnosis, and effective treatment of PTSD, particularly among professions with high public interaction like first responders, medical personnel, and teachers.Discussion Points:Understanding and Diagnosing PTSD: Tina defines PTSD and outlines its common symptoms, such as intrusive thoughts and hypervigilance. She elaborates on the diagnosis process, highlighting the CAPS-5 test and the PTSD Checklist as critical tools for accurately identifying the disorder.Effective Treatments for PTSD: The conversation shifts to treatment strategies, with a focus on cognitive behavioral therapy, group therapy, and the potential use of medication. Navigating PTSD in Workers Compensation: Tina, Matt, and Patty tackle the challenges of managing PTSD claims within the workers compensation system, stressing the need for specialized care and the difficulties associated with psychological injury claims. A success story is shared to illustrate the positive impact of appropriate and timely treatment.

Hosts Matt Yehling and Patty Reinecke are joined by Jeff Pack, a Medical Management Consultant at MEC, to discuss failed back syndrome. Jeff shares his experience dealing with complex back injury claims that often start as sprains or strains but can lead to multiple surgeries and the diagnosis of failed back syndrome. The episode explores common trends in these cases, potential interventions, and advice for managing claims involving failed back syndrome.Discussion Points:Sprains and Strains Leading to Excess Claims: Jeff explains how many back injury claims that reach the excess layer at MEC begin as sprains or strains but progress to surgeries, sometimes multiple, before arriving at a failed back syndrome diagnosis. He shares examples of cases involving a nurse and a mechanic to illustrate this progression.Common Trends and Potential Interventions: The discussion covers common back injury diagnoses seen in the excess world and potential interventions to prevent failed back syndrome. Jeff highlights the importance of addressing problems quickly, finding physicians aligned with the goal of returning employees to work, and considering tools like nurse case managers and second opinions.Risks and Complications of Spinal Cord Stimulators: Jeff delves into the risks and complications associated with spinal cord stimulators, which are sometimes presented as a "golden ticket" for pain relief in failed back syndrome cases. He emphasizes the need for thorough consideration and second opinions before proceeding with these devices.

Hosts Matt Yehling and Patty Reinecke welcome Dana Dorsey from MEC's Medical Management Unit to discuss sprains and strains. Dana, with her extensive background in field case management, dives into the definitions, treatments, and prevention of these injuries, highlighting how they can lead to complex claims if not managed properly from the outset. The episode focuses on practical advice for both employers and employees to handle and prevent these injuries effectively.Discussion Points:Defining Sprains and Strains: Dana explains the differences between sprains, which involve ligaments, and strains, which involve muscles or tendons. She outlines the symptoms, severity grades, and recovery processes for these injuries, providing a clear understanding of their impact.From Simple Injuries to Excess Claims: The discussion addresses how injuries that initially appear as sprains or strains can develop into more severe conditions, leading to significant claims. This segment underscores the critical role of early and accurate diagnosis in managing these injuries.Strategies for Prevention and Early Intervention: Highlighting the importance of preventive measures, Dana discusses ergonomic improvements, proper training, and early medical intervention. This part of the conversation emphasizes actionable steps employers and employees can take to minimize the occurrence and severity of sprains and strains in the workplace.

They explore key differences from catastrophic claims, focusing on disputed issues, medical care management, and disability assessment. Dan shares insights on the use of Independent Medical Examinations (IMEs) and emphasizes the value of involving opposing counsel. The episode highlights the need for a collaborative approach to improve outcomes for injured employees. Discussion Points:Investigating Migratory Claims: Dan explains the key differences between migratory claims and catastrophic claims, highlighting the importance of identifying disputed issues, managing medical care, and addressing disability in migratory claims.Effective Use of Independent Medical Examinations (IMEs): Dan offers insights into the strategic use of IMEs, emphasizing the need to consider their purpose and potential impact before proceeding.Collaboration and Communication: The episode underscores the value of collaboration and open communication among all stakeholders, including defense counsel, to navigate complex migratory claims and achieve the best possible outcomes for injured employees.

In this episode of MEC Connect, hosts Matt Yehling and Patty Reinecke sit down with MEC Senior Claims Analyst Kam Garrett to delve into the complex world of migratory claims. Kam shares a real-life example of a migratory claim that spanned over a decade and the challenges involved in handling such cases. They also discuss recurring trends, resources, and strategies for managing migratory claims effectively.Discussion Points:Real-Life Example: Kam provides a detailed example of a migratory claim that took almost 13 years to resolve, emphasizing the persistence required in managing such cases.Challenges in Handling Migratory Claims: Kam highlights the unique circumstances and evolving treatment plans associated with migratory claims, including prescription complexities, financial considerations, and posturing for settlement.Impactful Resources at MEC: Kam discusses the resources available at MEC, such as preferred pharmacy benefit management, experienced medical teams, cost projections, and structured settlement brokers, to help navigate and reduce costs in migratory claims.

Hosts Matt Yehling and Patty Reinecke interview MEC’s Sherrie Murray about the challenges of "migratory claims"—claims involving injuries that start simple but spiral into complex cases involving endless treatments and prescriptions. In this episode, we explain MEC’s approach to these thorny claims, focusing on appropriateness of care, prescription issues, and ultimately settling cases.Discussion Points:Nature of Migratory Claims: Common types of injuries in migratory claims, particularly involving the spine.Challenges of Migratory Claims: The medical, psychological, and employment-related challenges faced in these claims.MEC's Approach to Migratory Claims: Team of experts including medical management consultants and claims attorneys.Deep dive into claimant's current treatment, prescription complexities, and cost-effective settlement strategies.Importance of pre-MSA product evaluation and Medicare considerations.

In our final episode of Season 1, Matt Yehling and Patty Reinecke speak with Geoff Jones, Senior Claims Attorney at Midwest Employers Casualty (MEC) about resolution of catastrophic claims.Topics covered include:If and when a catastrophic claim can be settled.Situations where a settlement is not possible or recommended.  Considerations for indemnity or medical only settlements.The people involved in resolution of a catastrophic claim.How Medicare Set-Aside trusts affect settlement.

In episode 8, Kelly Loos, Senior National Catastrophic Claims Analyst at Midwest Employers Casualty (MEC), teams up with Matt Yehling and Patty Reinecke for a conversation about claim management once an injured employee has achieved medical stability.Topics covered include:Factors that need to be addressed before a CAT claim can be considered stable.Who is involved with following a catastrophic claim over the long term.  How to reserve for a claim – both initially and after the claim is stable. 

In episode 7, Matt Yehling and Patty Reinecke welcome back Phyllis Ramondetta, Senior National Catastrophic Medical Consultant at Midwest Employers Casualty (MEC).  They will discuss the factors involved for an injured employee to achieve the goal of returning home after a catastrophic injury.Topics covered include:Services and modifications that need to be in place before the employee’s return home.  How MEC helps facilitate a smooth and successful transition for the employee and their family. Options for attendant care, if required.The advantages of returning home versus long-term facility care.

In episode 6, Matt Yehling and Patty Reinecke welcome Phyllis Ramondetta, Senior National Catastrophic Medical Consultant at Midwest Employers Casualty (MEC), for a discussion on what to expect after the acute phase of a catastrophic injury.Topics covered include:Types of rehabilitation options available after hospital discharge.Injuries that benefit from post-acute rehabilitation programs.Characteristics of an effective rehabilitation program.Considerations for reaching an individual’s best possible outcome.

In episode 5, Matt Yehling and Patty Reinecke welcome back Midwest Employers Casualty’s (MEC) Chief Medical Officer, Dr. Fernando Branco.  The three discuss the significant role Centers of Excellence (COE) play in the rehabilitation of catastrophically injured employees.Topics covered include:Explain why MEC may recommend a COE for the treatment of a catastrophically injured employee.Differentiating COEs from other centers and how to choose the appropriate COE. Measuring treatment outcomes at a COEThe COE’s process and level of communication prior to admission, treatment, and discharge.Determining fair pricing.

In this installment of MEC Connect, Matt Yehling and Patty Reinecke chat with Midwest Employers Casualty’s (MEC) Chief Medical Officer, Dr. Fernando Branco.  Dr. Branco addresses the importance of proper medical treatment to achieve the best outcome for the injured employee. Topics discussed include:Initial steps of a successful catastrophic medical care plan.Trauma center classifications.The importance of investing in quality care.Treatment considerations.What constitutes a good outcome for a trauma center. Learn more about CAT Claims here: https://mecasualty.com/claims-admin/cat-claim.For inquiries about MEC Connect, email MECConnect@mecasualty.com.

In Episode 3, Matt Yehling and Patty Reinecke welcome Dan Dalton Chief Claims and Regulatory Counsel at Midwest Employers Casualty (MEC).  Dan addresses the benefits of having a lawyer involved in catastrophic (CAT) claim investigations.  Topics covered include:Necessity of attorney retention and involvement on day one in catastrophic losses. The “grand bargain” of the no-fault system of workers’ compensation.Overview of third-party liability and subrogation.The methodology and importance of a thorough claim investigation to a successful outcome.Learn more about CAT Claims here: https://mecasualty.com/claims-admin/cat-claim.For inquiries about MEC Connect, email MECConnect@mecasualty.com

Matt Yehling and Patty Reinecke welcome back Courtney Waltz, Senior National Catastrophic Claim Analyst at Midwest Employers Casualty (MEC), to continue their discussion about MEC’s unique approach to CAT claims management.  Topics covered include:Why the right team matters.How MEC has utilized technology to enhance the CAT claims round table process.The importance of communication to enhance the quality of care.How MEC makes a difference.Learn more about CAT Claims here: https://mecasualty.com/claims-admin/cat-claim.For inquiries about MEC Connect, email MECConnect@mecasualty.com.

Welcome to the first episode of MEC Connect! Special guest Courtney Waltz, Senior National Catastrophic Claim Analyst at Midwest Employers Casualty (MEC), joins cohosts Matt Yehling and Patty Reinecke for the first in a series of discussions about catastrophic (CAT) workers’ compensation claims.Topics covered include:·         How the MEC dedicated CAT Claims team defines CAT claims ·         Who makes up the CAT Claims team·         The  initial reporting process for these types of claims·         Why immediate action for CAT claims is critical to helping achieve better resultsLearn more about CAT Claims here: https://mecasualty.com/claims-admin/cat-claim.For inquiries about MEC Connect, email MECConnect@mecasualty.com.

Welcome to MEC Connect! We’re excited about the launch of our new podcast. Check out the trailer to get a sneak peek on what you can expect in Season 1!