Sapers & Wallack
Case Studies
Group Benefits Case Study #1
Client:
A Software Development company.
Issues:
Our client, a software developer, received notice that its stop-loss insurance carrier had rejected $80,000 in claims on a claim that exceeded $400,000. The carrier rejected the claim based on the fact that the request for payment was submitted after the policy year. The contract required all claims to be submitted to stop-loss carriers prior to the end of the policy year.
The Solution:
Sapers & Wallack didn’t just accept the rejection of the $80,000 in claims; we wanted to dig deeper so we requested the claims payment logs and determined that the claims administrator had received the claims in time to be processed within the policy period. However, due to internal delays at the administrator, the claims were not processed within the policy year as required by the insurance contract. Sapers & Wallack successfully negotiated with the insurance carrier to reimburse the client for these claims.
Outcome:
Because of our due diligence, Sapers & Wallack’s client saved $80,000.
Case study for illustrative purposes only. Individual results may vary.
Group Benefits Case Study #2
Client:
A Corporate Law Firm.
Issues:
Our client, a law firm, had an employee who worked intermittently over a two year period during his terminal illness. The law firm did not realize that there were Long Term Disability benefits available to the employee even though the individual was working at a diminished capacity.
The Solution:
When the employee passed away, we assisted the law firm in processing the death claim for the employee’s surviving spouse. Sapers & Wallack’s questioning of the nature of the claim and the employee’s duties uncovered the employer’s oversight in not filing Long Term Disability. Sapers & Wallack met with the insurance carrier to review the individual’s health history. It was Sapers & Wallack contention that the employee was unable to perform any duties due to the severity of his disability and that the firm was letting him come to work as a humanitarian gesture. Sapers & Wallack’s position with the carrier was that the salary being paid was salary continuance, not pay for services rendered.
Outcome:
The insurance carrier agreed with our analysis and based on our recommendation paid two years of Long Term Disability benefits to the employee’s widow in the amount of $200,000.
Case study for illustrative purposes only. Individual results may vary.
Group Benefits Case Study #3
Client:
A Large Retail Chain.
Issues:
A large retail chain was facing a $450,000 increase in their costs for providing life insurance, long term disability and short term disability to their employees.
The Solution:
Upon review of this prospective client’s claims experience, growth and demographics, we concluded that the current carrier was not taking into account three important factors. First, the poor claims history was based on just a few high earners. Secondly, the chain was about to embark on a rapid growth plan. Lastly, a comparison of the current demographic with past years showed that the current group was a much improved group. We prepared specifications which emphasized these three issues for the large retail chain which better positioned them to reduce the cost of coverage.
Outcome:
Sapers & Wallack was able to obtain competitive quotes that allowed the client to contain their coverage at the present rates. This represented a savings a $450,000 and a new client for Sapers & Wallack.
Case study for illustrative purposes only. Individual results may vary.
Group Benefits Case Study #4
Client:
A Hi-Tech corporation.
Issues:
Our hi-tech corporate client with over 2,400 employees wanted a benefit plan summary for new hires as well as long-term employees. The hi-tech company was going to create a benefit handbook, but the client was concerned about the initial cost for design as well as subsequent reprints to reflect plan changes.
The Solution:
Sapers & Wallack implemented MyBenefitsView, a unique web-based communication tool that offers employees 24/7 access to their benefit information. The site has benefit summaries, enrollment forms, claim forms, links to carriers’ websites and directories and Sapers & Wallack provides on-going training and assistance for all new hires as well as existing employees.
Outcome:
Sapers & Wallack’s client now has a dynamic, well-maintained benefit site for all employees and has saved thousands of dollars in printing costs and increased the employees’ appreciation of their benefit program.
Case study for illustrative purposes only. Individual results may vary.
Group Benefits Case Study #5
Client:
X-Ray Detection Technology company.
Issues:
After being named broker of record, Sapers & Wallack conducted our initial audit of the group benefits plan. We discovered that, in relation to the life and disability coverages, the employer was reporting and paying premiums on salary increases as they occurred. The contracts only required that these increases be prepared on an annual basis.
The Solution:
Sapers & Wallack identified the over payment and corrected the employer’s internal process.
Outcome:
Sapers & Wallack negotiated a refund from the carrier for thousands of dollars of overpaid premiums.
Case study for illustrative purposes only. Individual results may vary.
Group Benefits Case Study #6
Client:
A Non-Profit Social Service Provider
Issues:
Our client was experiencing rapidly increasing medical costs for their employees. Their claims experience included many high dollar claims.
The Solution:
Based on Sapers & Wallack’s recommendation, the client instituted an aggressive wellness program and disease management program. Employees now participated in a Health Risk Assessment prior to joining the plan in order to target the appropriate disease management program for high and medium risk beneficiaries.
Outcome:
Sapers & Wallack has helped the employer contain its costs. In subsequent renewals, the increases have been significantly below medical trend.
Case study for illustrative purposes only. Individual results may vary.