Frequently Asked Questions - FAQ

Who is Insurance Recovery Group (IRG)?

Insurance Recovery Group, Inc, (IRG) is a national recovery and cost containment company focusing on workers' compensation for the insurance industry. We are expert in workers' compensation second injury fund recovery (SIF) for insurance companies, TPAs, employers, and self-insureds. Through a combination of skilled attorneys and claims professionals focused on second injury fund claims and, a proprietary databank of rules, regulations, procedures, and state-specific strategies, we have recovered over $900 million for our clients. In addition to second injury fund recoveries, we offer cost of living adjustment (COLA), and other recovery management services provided through our service partner relationships for social security offset, social security advocacy, and medical advisory services.

What services does IRG provide?

IRG provides second injury fund (SIF) and cost of living adjustment (COLA) recovery services on a total outsource basis for claims that have not been previously identified, or processed on an accurate or timely basis. We perform the complete recovery process, including reviewing workers' compensation open claims (and closed in certain states) for potential, investigating and locating all medical records and employer statements as required, perfecting and filing claims for recovery with the state fund, negotiating settlements with the state funds, and providing detailed, customized reports for clients on payments and claims progress.

In addition to SIF and COLA recoveries, IRG offers, through our service partners, recovery management services for:

Social security offset;

Social security advocacy; and

Medical advisory services

How much money does second injury fund recovery involve?

The laws vary significantly from state to state. In New York State, for example, the average second injury recovery claim results in approximately $40,000 of initial retrospective recovery and $300,000 of future recoveries. For an Insurance Company or Self-Insured Employer, such future recoveries allow for an immediate reserve reduction. In New York, roughly 12% of all long term workers' compensation claims should result in a second injury fund recovery. Thus, of every 100 long term workers' compensation claims in New York, there is potential for approximately $480,000 in initial retrospective recoveries, and $3,600,000 in future recoveries and reserve reductions.

What states offer the best opportunities?

In order of largest opportunity, the following states, which we call reimbursement states, have the best recovery potential: New York, Massachusetts, New Hampshire, South Carolina, Louisiana, Nevada, Arizona, and Alaska, as well as the following states, which have closed their funds prospectively: Florida, Washington D.C., and Georgia. Other states have opportunities for transfer of the second injury fund liability, such as New Jersey (which takes over future payments) and California (apportionment).

What are the benefits of outsourcing to IRG?

Second injury fund recovery is IRG's core competency and our legally based process will maximize SIF recovery dollars and reserve reductions for every company. We are able to accomplish this through a proactive recovery system that utilizes experienced attorneys and recovery specialists with both medical and claims knowledge following comprehensive, structured, Best Practice recovery procedures. Together with our propriety data base of rules, regulations, state specific strategies, and "out of the box" thinking when appropriate, this process results in the earliest possible claims resolution and maximum recovery.

Benefits extend beyond recovery dollars and reserve reduction in that our programs assist our clients to accelerate recovery cycles, accurately forecast financial results through customized recovery reports, reduce litigation costs, help resolve underlying claims sooner, allow adjusters to focus on their primary responsibilities, and institute a "Best Practice" single source, nationwide solution for maximizing recoveries.

Who has benefited from IRG services?

We have worked on a contingency basis with many major insurance companies, TPAs, self-insureds, trusts, and employers with high retentions. Our clients include ACE, AIG, Electric, Fireman's Fund, General Motors, Kemper, Royal & SunAlliance, The Boston Globe, and The Hartford. A more complete client list is available upon request.

Why is IRG so successful on behalf of its clients?

We are experienced in recovering from second injury funds in all reimbursement states, and together through our captive law firm, we are able to manage the recovery process from "cradle to grave." We follow Best Practices in our recovery process to ensure that we are maximizing recoveries for our clients.

In addition, we are capable of managing the data and quality control for any other SIF vendors who may provide recovery services to our clients, so that there is one Best Practice standard for performance and one SIF recovery database. Our information systems manage and track the quality of work provided and ensure that continuous quality improvement is in place. Finally, we continuously monitor legislative actions that may affect recovery and suggest proactive solutions to our clients.

For a copy of our Best Practice Checklist, please click here

Are initial claims reviews free?

At no cost, we will perform a second injury or COLA claim review and submit a report of our findings to a prospective client. Based upon our findings, we will then discuss recovery opportunities, and initiate an aggressive and systematic recovery process. Our clients have absolutely no risk and incur no contingency fee, unless and until, IRG successfully obtains a second injury fund recovery.

How involved are our claims handlers with the second injury fund recovery process?

The SIF recovery function, once it is outsourced to IRG, is not in any way disruptive to claims handlers, who have minimal to no involvement in the process. We have a great deal of experience in seamlessly and quickly integrating our processes with existing claims operations. We communicate claims strategy and the status of all recovery opportunities on a periodic basis to the claims handler and client manager, through individual and/or customized reports.

How is the injured employee affected?

The injured employee is not affected in any way. The employee collects benefits without disruption to the timing or amount of benefits received.

How can IRG's services provide a single-source solution for the client?

Today it is not enough to be a small local second injury fund vendor in a single state, or even a couple of states. Customers want a fully integrated, enterprise-wide, recovery solution through a single source. IRG's focus is countrywide and enterprise-wide, enabling us to do several things on behalf of all our clients:

Offer a variety of programs, either on a jurisdictional or enterprise-wide basis, including total outsourcing.

Integrate and coordinate the recovery process and/or settlement with claims personnel.

Manage other vendors' performance and report their data while enforcing Best Practice in those situations where another vendor is required due to the client's business needs.

Track all jurisdictional legislative changes and reforms that affect each individual client through one focal point for information.

Customize enterprise-wide reports, detailing the recoveries made, the future value of recoveries, and the timing of such recoveries.

What types of reports are available from IRG and what is the frequency of reporting?

Reports Include:

File Review Reports

Individual Case Reports

Multi-State Client Reports

End of Year Reports

IRG provides a report shortly after any file review with a description of the number of files reviewed, and which ones IRG identified for potential SIF recovery. Individual case reports are sent to the adjuster soon after IRG opens the claim and periodically during the investigation and processing of the claim.

Complete multi-state client reports are provided on an agreed-upon basis during the year, with a listing of all active claims and their current status in the SIF process. These reports can be customized to fit the client's requirements.

End of the year reports, summarizing the year's activity, generally contain the claim status, amounts recovered, value of cases in the pipeline, and expected recovery to allow the client to use the data for forecasting purposes.

Throughout the claims recovery process, potential recovery values are updated as relevant data from the investigation process impacts estimated amounts. This information can be provided on demand to the client, on a claim-by-claim basis.

How do we get started?

Typically, we only need a list of claims that fit our file review criteria in order to give you a preliminary evaluation of the opportunity. If the list of claims is sent to IRG in a spreadsheet, we can sort them for you to determine how many qualify for an audit.

Once we have a list of qualified claims, we make arrangements to audit the files for recovery potential. Depending on the volume and location of qualified files, the files simply need to be pulled and placed in a centralized office/space for our team to review or, at our expense, shipped to us for review and promptly returned to you.

Further recoveries are initiated by periodic reviews performed by us, or by direct referral of claims by your claims handlers.

How does IRG get paid?

We are typically paid a contingency fee after reimbursement is received by you. This arrangement completely aligns our interests with yours, namely successful recoveries.