Claims Services

Protecting Our Global Community of Customers

Workers’ Compensation Managed Care Programs
Cost Containment Programs
Preventing escalating medical disability cost requires early intervention through a series of cost containment strategies including
a comprehensive Managed Care Program. Tokio Marine America offers a variety of options through our internal resources as wellas outside vendors to assist you in implementing a Managed Care and temporary early Return to Work program that achieves
your goals of containing claims costs. You may already have pieces of this program in place. You can either add to your existing
program or create an entirely new program by selecting from the options below:

Managed Care Organizations

Temporary Return to Work Offsite

Managed Care Organization savings are achieved byextending medical control and channeling medical care toquality network providers. Some states offer a Certified
Managed Care program allowing employers to legally extend
periods of medical control by directing care into a network
where injured workers may receive treatment by quality
physicians with experience in treating workers compensation
patients. Tokio Marine America currently offers formal
Managed Care Organizations in California and Texas. Temporary Modified Duty Off-Site or Modified Duty Off-site
Program is a unique program offered to employers to assist
them in returning their employees back to work following aninjury or period of disability. The injured worker is placedwith an area non-profit agency to provide volunteer
placement for employees with temporary restrictions thatare not able to return to their original job while they arerecovering from their injuries. Each case is handledindividually, with placements generally lasting no longer
than 90 –180 days. 

Temporary Return to Work Policies andProcedures Manual

Preferred Provider Organizations

Tokio Marine America has developed a temporary Early
Return to Work Policy and Procedures Manual designed toassist you in formalizing your temporary early return to work
program. Depending upon your resources, this aspect of theProgram can be created and implemented internally or
alternatively outside vendors can assist with variouscomponents. 

Tokio Marine America offers access to a comprehensive listof medical care with industrial clinics and hospitals.
Preferred Provider Organizations networks maximize
savings to our clients through discounted rates withparticipating providers. Our online Provider Search
Directory allows users to searches for providers in various
specialties within their area and assist in creating postingnotices.

Nurse Case Managers
Tokio Marine America assigns certified professional nurses
based on the type of injury, severity of injury, chronicity ofclaim as well as other issues that may require the involvementof the Nurse Case Managers.

Medical Bill Review

Utilization Review

Pharmacy Savings Program

Pre-certification of medical treatment to ensure all treatment
requests are administered by the appropriate medical
professional using nationally recognized guidelines to ensure
all authorize medical procedures are medically necessary.

Lower prescription costs by utilizing network pharmacies,
control overutilization and simplify filling prescriptions withno out of pocket expense. This program offers uniquesolutions to provide appropriate prescription benefits to theinjured workers while increasing the overall cost savings forthe insured.

Control cost by identifying over-utilization, overcharging,
miscoding as well as other abuses and paying only fortreatment that is medically necessary.

To learn more about Tokio Marine America's Managed Care Programs available in your state please log-on to
http://www.tmamerica.com or e-mail managedcare@tmamerica.com.

A service of the Tokio Marine America Claims Department.
TMM is committed to the highest customer trust.
We exist to deliver ANSHIN (safety, security and peace of mind) to our customers by providing the highest quality services.
This information is provided solely as a client service. Tokio Marine Management, Inc. does not represent, warrant, or guarantee the appropriateness, validity or accuracy of this information in every situation.
This information does not necessarily cover every possible condition, protection, hazard, situation or exposure and is not warranted to be in compliance with laws, regulations, codes or standards in every
jurisdiction. This information is representative of reasonable practices in the industry. However, you may wish to investigate whether these recommendations are applicable to your specific operations. Losscontrol is the responsibility of your management. | © 2023 Tokio Marine America, All Rights Reserved.
Tokio Marine America (TMA) is the marketing name for Tokio Marine America Insurance Company (TMAIC), Trans Pacific Insurance Company (TPI), and TNUS Insurance Company (TNUS).