Author: Kaya Stanley, Board Chair and CEO, CRMBC
Running a restaurant comes with its share of challenges— managing food costs and labor to ensuring a great guest experience. However, many restaurant operators overlook workers’ compensation until it becomes a costly problem. Properly managing workers’ compensation can significantly impact your bottom line, and knowing how to partner with CRMBC’s Third-Party Administrator (TPA) can make all the difference.
In a recent Self-Insurance Podcast episode, CRMBC CEO Kaya Stanley spoke with Randy Bugg, Vice President of our TPA, Pacific Claims Management, about the vital role TPAs play in self-insured groups. Randy shared critical insights on how effective claims management and personalized attention can lead to better outcomes for employers and employees.
1. Understanding PCM’s Role and Capabilities
Pacific Claims Management is more than just a claims processor—it functions as the claims department for CRMBC members. PCM’s role is to ensure compliance with workers’ compensation laws while managing claims to benefit both the employer and the employee. As Randy Bugg explains, “We handle claims in the interest of the employer, ensuring fair treatment for both the injured worker and the company.”
Treating PCM as an extension of your operations helps foster a collaborative approach to claims management. Understanding PCM’s role—particularly its commitment to fairness, efficiency, and transparent communication—will help you maximize this partnership.
2. Open and Consistent Communication
Clear and open communication is key to optimizing your relationship with PCM. Randy highlights the importance of regular contact: “Honest dialogue means the good, the bad, and the ugly.” Stay in touch with PCM to ensure they align with your goals and address potential issues early.
Make it a priority to check in with your dedicated PCM adjuster regularly. Whether discussing claims routinely or addressing specific concerns, these touchpoints ensure PCM understands your business’s priorities and focuses on the right areas.
3. Proactive Claims Management
PCM’s proactive approach to claims management is one of its core strengths. Unlike traditional insurance models, where employers may not hear about claims until settled, PCM encourages early reporting and active involvement. This approach minimizes surprises and ensures potential issues are addressed before they escalate.
Randy explains, “We want to take the surprises out of the claims process.” By working closely with PCM, CRMBC members can ensure claims are resolved quickly, reducing long-term costs and ensuring employees receive the care they need.
4. Leveraging PCM’s Dedicated Adjusters
One major benefit of working with PCM is assigning a dedicated adjuster to each CRMBC member. This adjuster becomes intimately familiar with your operations, safety protocols, and employee needs. Unlike traditional models where multiple adjusters handle claims, PCM ensures consistency and better outcomes by building long-term relationships.
As Randy notes, “The best outcomes are achieved by really gaining intimate knowledge of the employer and the claims adjuster over time.” This continuity fosters trust and ensures that claims are managed per your business’s priorities.
5. Focus on Employee Well-being and Return-to-Work Programs
Workers’ compensation isn’t just about controlling costs—it’s also about ensuring injured employees receive the care they need and can return to work safely and quickly. PCM works with CRMBC members to develop Return-to-Work (RTW) programs that help injured employees transition back into the workforce in modified roles, benefiting both the employee and the business.
As Randy emphasizes, “Successfully returning someone to work saves on disability time and medical costs.” Engaging PCM in the RTW process ensures employees remain productive during recovery and that your restaurant experiences minimal disruption.
6. Fraud Detection and Prevention
Fraudulent claims can drain valuable resources, so PCM prioritizes early fraud detection. They use private investigators and social media monitoring tools to identify suspicious claims. Randy shared examples of how PCM’s proactive fraud prevention strategies have saved CRMBC members from costly false claims, ultimately protecting the group’s bottom line.
Members can use these robust fraud prevention measures by working closely with PCM to ensure that all claims are legitimate and handled correctly.
Optimizing your relationship with Pacific Claims Management can significantly impact workers’ compensation outcomes. By understanding PCM’s role, maintaining open communication, leveraging proactive claims management, and benefiting from their dedicated adjusters and fraud prevention measures, CRMBC members can ensure that PCM is focused on the right priorities for their business.
A strong, collaborative partnership with PCM improves the claims management process and creates a safer, more productive work environment for employees. If you’re a CRMBC member, developing this relationship with PCM can help you take greater control of your workers’ comp program and achieve better results for your business and workforce.
And if you’re a restaurant operator looking to take control of your workers’ comp program and reduce costs, contact CRMBC today to learn how a self-insured group with the right TPA can transform your approach to workers’ compensation.
Kaya Stanley is an attorney, published author, business owner, and highly sought-after strategic turnaround expert. Ms. Stanley serves as CEO and Chairman of the Board for CRMBC, the largest restaurant workers’ compensation self-insured group in California, and she is the Licensee for TEDxReno, an independently organized TEDx Event.
Throughout her 22 years of practicing law, Ms. Stanley has served as outside counsel for Wal-Mart and Home Depot. She was voted one of the country’s “Top 25 OZ Attorneys” by Opportunity Zone Magazine and published a best-selling book called “The Employer’s Guide to Obamacare.” Before that, she earned her master’s degree in social work and public policy, after which she worked with at-risk girls in Detroit and lobbied for women and families.