Settlement Tools

Through an integrated medical, pharmacy, claims and legal approach, our best-in-class tools help to reduce overall cost for claims that may not settle or reduce costs prior to performing a workers’ compensation or liability Medicare Set-Aside (MSA/LMSA) allocation. These services include:

Medical Reserve Forecast (available for Workers’ Compensation only)
PMSI's Medical Reserve Forecast (MRF) outlines all future medical needs and associated costs for the expected life of the claim. Intended for use when settlement is not possible, our exclusive MRF helps identify the probable ultimate medical cost of a claim, including physician care, surgery, medications, and medical equipment, etc. The forecast assists with more exact claim reserving and helps to prevent stair-stepping. The MRF can be tailored to your claims system and reserving worksheet for easy import capabilities.

Future Medical Cost Projection
PMSI’s Future Medical Cost Projection is an unbiased independent medical review that takes into consideration all future medical treatment for the claim. The Future Medical Cost Projection estimates the total future medical exposure based upon expected medical needs, pre-existing injuries, co-morbid conditions, and life expectancy of the injured individual. Primarily used to determine and negotiate a settlement, the written summary details the costs by category, and can be attached to the settlement documents. PMSI will include an MSA/LMSA at no additional charge if requested at the time of referral.

Drug VALUE Review (DVR)
PMSI’s DVR is a comprehensive assessment and drug cost allocation forecast based on our industry expertise as a Pharmacy Benefit Manager (PBM) and published clinical research on drugs common to workers’ compensation and liability claims. The review assesses current medication utilization, confirms medications are appropriate for the primary injury, and evaluates appropriate medication utilization over the projected lifetime of the injured worker. In addition, the intricate algorithm looks at key factors that drive up prescription allocations and mitigates drug costs by assessing for tapering allowances, Medicare Coverage Guidelines, patent expirations, etc. The DVR is an optional companion to an MSA/LMSA and is recommended for all claims that contain high-cost drugs to reduce the overall pharmacy portion of an allocation.

Medication Review
A Medication Review provides an individualized evaluation of an injured individual’s pharmacy and medical records by a PMSI clinical pharmacist to identify any medication-related concerns and develop an action plan for problem resolution. The thorough review results in a detailed report that contains specific clinical recommendations regarding the individual’s therapy and the supporting drug information. The report is provided to the claims professional and physician(s) involved in the claim for resolution of identified concerns. When recommendations are followed, a Medication Review helps to eliminate unnecessary or inappropriate therapies, reducing ongoing health care expenses, and the overall claims cost. Intended for high-risk, actively managed cases that either may not be settled or will be settled in the next year, the Medication Review helps ensure that the injured individual is on the right medication regimen for optimal long-term outcomes.

Medication Review with Peer-to-Peer Outreach
Upon request, after a PMSI Medication Review is preformed, a PMSI physician will reach out to the prescriber(s) and invite them into a collegial discussion to better understand the clinical situation of the claim. The PMSI physician will help to educate the prescriber(s) regarding appropriate therapeutic options and facilitate the implementation of the recommended changes to the therapeutic plan.