Biography

Edward Hiller

Edward L. Hiller is the former Director of Claims and Medical Operations for the New York State Insurance Fund.

In that capacity, Ed set policies, practices and procedures for NYSIF’s claims operation and oversaw the work of the Fund’s 1,600 claims employees in 12 business offices throughout New York State.

NYSIF is New York’s largest worker’s compensation carrier with more than 40% of the market. NYSIF has 175,000 policyholders with annual premiums of $1.7 billion and has over 130,000 active claims. The Fund pays out over $1.4 billion in compensation and medical payments each year.

An attorney, Ed served as NYSIF’s chief of litigation for most of the 1990’s and played a major role in the successful implementation of the 1996 “grave injury” reforms that still yield enormous savings to NYSIF’s bottom line. Ed is a recognized authority in all aspects of personal injury defense, with special expertise in the Labor Law. A well-known master negotiator, Ed’s skills literally saved the Fund millions of dollars as a result of creative litigation strategies and remarkably favorable settlements.

In the late 1990’s, the Fund was foundering and on the verge of liquidation.  The claims operation was dysfunctional.  Staffers relied on paper files that could not be found.  Claimants were receiving their benefit checks late or not at all. Medical providers were not being paid. The situation was chaotic, and desperate.

The Fund’s new executive team, appointed by then governor George Pataki, quickly learned of Ed’s stellar reputation as a can-do manager and inspirational, charismatic leader who knew how to get things done. Wisely, they reached out to Ed to take over the claims operation, and, in reality, to save the Fund from financial disaster.

Ed took on the challenge, and the rest is history.  Through his hard work, innovation and inspirational leadership, Ed pulled the Fund into the 21st century. He mounted several “crusades,” each building upon the last, to transform NYSIF into the very model of a first-rate, competitive insurance carrier.

First, he established zero tolerance for late bills and penalties. At the time, NYSIF had at least 300,000 late bills in its inventory (the Fund receives about 1.5 million medical bills per year.) Today, NYSIF has no late bills and penalties are virtually non-existent.

Next, Ed convinced the executive team that the Fund would never truly change unless and until staffers were weaned off the archaic paper claim file and compelled to accept NYSIF’s excellent, but underutilized electronic claim file. He received the necessary authority, and in October of 2000 announced that effective June 1, 2001, all paper files would be locked away and form that point forward claims would be processed from cradle-to- grave using only the electronic case file.

Ed then embarked upon a statewide campaign in which he sat down in group settings with each and every one of NYSIF’s 1,000 case managers and taught them how to use the electronic file while preaching the gospel that change is hard, but change is good.

This approach paid off. In the nine months leading up to the June 1, 2001 deadline, each and every one of NYSIF’s 300,000 claims was reviewed. Simply as a result of actually looking at each case, fully one-third were found to be “dead wood” and were promptly closed. The rest were successfully established as electronic files. A new era had begun at the Fund.

The transformation to a “paperless” environment yielded immediate dividends in the aftermath of the tragic events of September 11, 2001.  NYSIF’s home office is located in Lower Manhattan just seven blocks from Ground Zero.  Half of all the Fund’s claims are managed out of that location, which was effectively shut down for two weeks as downtown struggled to regain its bearings. However, since the switch to electronic case management had been made, the Fund’s district offices elsewhere in the state were able to pick up the slack and manage the cases remotely from their desktops. The result:  The Fund did not miss a beat. All claimants were paid timely, as were providers. A public relations catastrophe was averted.

In 2003, Ed went back on the road to preach the gospel of “Reserve, Strategy, Diary,” his trinity for successful case management.  Within a relatively short time, the Fund transitioned from its notorious “step reserving “past to timely and accurate reserving.

Having righted the ship and set the Fund on a steady course, the final years of his tenure were dedicated to spearheading major enhancements to NYSIF’s claim operation, resulting in enormous savings in money and time including establishing a partnership with a nationally known pharmacy benefit manager, implementation of electronic receipt of medical bills, and a treatment verification project to combat fraud.  At the same time, Ed successfully oversaw NYSIF’s compliance with the myriad statutory mandates associated with the sweeping workers’ compensation reform legislation of 2007. Additionally, Ed’s leadership and advocacy for Sec. 32 lump-sum settlements resulted in savings to the Fund of over $700 million dollars in the period 2000-2011.

Ed Hiller is one of the best known, most respected and well-liked people in the industry. He served two terms as president of the New York Claim Association, which later honored him, in December, 2008, for excellence in service to the insurance industry before a record crowd at the Harvard Club.

Mr. Hiller  is a member of the New York State Bar Association, AASCIF, AMCOMP and the New York Claims Association, of which he is a past president. He is admitted to the practice of law in New York and New Jersey as well as in the United States District Courts for the Southern and Eastern Districts of New York.  In 2003, Mr. Hiller earned the designation Workers’ Compensation Professional (“WCP”) from AMCOMP.

Upon his retirement from NYSIF in August 2012 after 30 years of service, Ed founded Smart Claims Solutions, LLC, a health care consulting venture with special emphasis on claims oversight, cost containment and connectivity.

Ed is also an expert witness in worker's compensation and personal injury cases. In that capacity he has been retained by major law firms, Guidepoint Global, Gerson Lehman Group Councils and Atheneum Partners.

Mr. Hiller is the president of SCS.  Ed has had numerous publications over the years for AMCOMP and NYCA. Some of these can be found on his website under Publications.