Self-Managed vs TPA Managed: Are You Maximising the Benefits of Your AEP?

The Accredited Employer Programme (AEP) can be appealing and cost-effective for large employers seeking to lower costs and self-manage injury claims within their workforce. Facilitated by the Accident Compensation Corporate (ACC), this scheme allows large organisations to take control of their ACC levies, actively manage their Health and Safety environment and the total cost of when employees injure themselves at work, often resulting in better outcomes for their injured employees. The AEP enables the organisation to ‘step’ into the shoes of the ACC, but it does come complete with the obligations that ACC has to injured workers. These responsibilities when managing workplace injury management claims require considerable skill, time, knowledge and resourcing – a limitation for many organisations wishing to leverage the many benefits of participating in the AEP.

These limitations can play out in many forms, including; not having a claims team with adequate knowledge of the correct adjudication and legislation to apply which can result in additional claims costs, lack of independence when handling colleagues claims, availability of advanced claims management platforms and best practice, lack of data and analytics when coupled with manual and antiquated processes resulting in excessive administrative costs, not to mention the advances and best practice in the rehabilitation. These risks are only compounded when staff retention is challenged. To counteract these challenges, part of the ACC’s AEP program allows companies to manage their claims through a third-party claims administrator (TPA).

TPA’s support a variety of government departments and agencies, well-known large New Zealand businesses and self-insured companies with their workplace injury claims, applying their highly skilled people to problem solve those existing AEP challenges and deliver superior claims management and resolution. In this article, Steven Walsh (Chief Client Officer) writes about how your AEP program can be maximised through partnering with a TPA.

First, what are the constraints of using the AEP program?

The AEP program can be ideal for large employers that have the desire and capabilities to take control of their workplace health and safety practices and have a ‘hands on’ involvement to ensure that injured employees are provided with the best possible outcome when injured performing their duties at work, which, with the impact of COVID-19, now includes those injured when working from home.

Meeting the criteria set by ACC

To be eligible to join the ACC’s AEP program, employers must meet various requirements including being able to:

• Demonstrate their experience and commitment to effective workplace health and safety
• Show their commitment to preventing injuries and providing the support and time for rehabilitation should it be needed
• The policies, procedures, and resources for injury prevention, claims management and rehabilitation provide audited financial records that show the business’ financial strength and stability to meet the costs of their employees’ cover and rehabilitation
• Pass an on-site audit conducted by an ACC approved auditor

Even after your business has been accepted into the program, there are still limitations and obligations to the program that need to be understood before deciding if the AEP program is best suited for you. These include, but aren’t limited to:

• Ensuring that you have the right cover plan option for your business. Options include whether the business will assume responsibility for claim management only until the end of the nominated claim management period and the financial liability ceases at the end of the claim management period, or will the business assume responsibility for claim management to the end of your claim management period but financial liability remains for the lives of the claims.
• Responsibility to the employee is not always capped (but it can be) – if an employee is injured or harmed in a fatal or serious workplace injury, you, as their employer, could be liable for supporting their financial needs for the entirety of the claim. The claim does not expire if your business leaves the AEP program.
• Managing your participation in the AEP requires time and dedicated resources. If you do not follow the program, or manage your employees claims accordingly, the cost and time requirements of being part of the AEP program could be greater than your previous levy.

How can a business overcome these challenges?

Navigating the AEP requirements when managing claims can be daunting – which is where TPAs, like Gallagher Bassett, come in to offer support and guidance to your business.

It might seem counter-intuitive to partner with a claims administrator to manage your own people’s claims, but it’s often far more effective (in both costs and time) than managing your AEP internally or simply reverting to the status quo of having ACC manage your injured employees. When you work with our team, you get access to a group of industry experts who are committed to a career in claims. We can provide claims professionals that are knowledgeable and experts in their field, that are continually instigating best practice in injury management, in an environment where they have development and growth opportunities to build a career at a company where claims are the core of what we do.

This means your employees receive tried and tested end-to-end support. From supporting businesses with their injury prevention strategies, to having dedicated claims managers who know your company’s people, processes and policies like their own, our team partners with yours at every step.

Companies who engage a TPA to overcome these challenges often see better rehabilitation outcomes and reduced return to work timeframes, meaning healthier employees and a healthier bottom line.

Find out more about how your organisation can maximise the most out of your AEP by visiting our Injury Management dedicated webpage or connect with Steven Walsh at steven_walsh@gbtpa.co.nz.