It’s not ALL on the insurer and/or employer to process workers comp claims. A joint effort is required by the employer, employee, insurer and TPA because when workers compensation claims are filed and processed quickly they are much less likely to become long-term claims. There is a much higher probability of claims “getting out of control” when control is not exercised at the start of the claim. Everyone has a part to play.
7 Standard Employer Tips
Employers who expedite their workers compensation claims handling:
1. Have a strong safety program to prevent many accidents from occurring. Safety programs are known to reduce the severity of the accidents that do occur.
2. Post all state required notices where all employees will see them and know what to do in the case of an injury.
3. Post the approved the medical provider(s) [in the states where the employer selects the medical provider], or post the suggested medical provider(s) [in the states where the employee selects the medical provider] with the notation the employee can select their own doctor.
4. Report the claim immediately after the accident (not the next day or the next week) to the insurer or TPA who will handle the claim. If you do not already know who the adjuster will be for the work comp claim, ask the claims office for the adjuster's name and phone number, then call the adjuster and ask if he/she has all the information needed. (WCxKitz)
5. Remain actively involved in the workers comp claim. Make sure the employee's supervisor and any witnesses are available to talk to the adjuster. Advise the adjuster of any contact you receive from a medical provider or an attorney representing the employee.
6. Stay in contact with the employee. By keeping the lines of communication open with the employee, the claim will move faster and the risk of an adversarial situation is diminished.
7. Have an active and effective return-to-work program. Provide the doctor with a written outline of the employee's job duties and physical requirements. Numerous studies show when employees return to work on modified duty or light duty the overall cost of both medical care and indemnity benefits are reduced.
11 Proactive Employer Tips
Employers who are on top of the claims process also take these proactive steps:
1. Coordinate between the risk management department and the human resources department to provide immediately to the adjuster.
2. Review the employee's job application (which should include pre-existing medical conditions both non-work related and work related).
3. Prepare the required payroll information and submit it to the adjuster within 48 hours of the accident report.
4. Provide a list of all previous work comp insurers and TPAs.
5. Provide a list with basic details of all prior workers compensation claims with previous TPAs or insurers.
6. Give an explanation and details of any disputes the employee has with the employer.
7. Provide a list of any absences from work, other than vacations and single sick days.
8. Provide the employee's personnel file (where state law permits). (WCxKitz)
9. Timely filing of all state required forms [timely being defined as quickly as possible, not within the 30-day window given by the state].
10. Large employers need to consider an on-site nurse or doctor to treat the employee immediately following the injury rather than the delay entailed by the employee going to the emergency clinic or even waiting to get an appointment with a doctor.
11. Educate the employees on what they can do to expedite their work comp claim.
9 Employee Recommendations
Your employees are just as anxious as you are about getting their workers comp claim processed and paid quickly. Post these recommendations and give them to your employees in a pamphlet when a workplace injury occurs.
1. Report any accident immediately to your supervisor or manager.
2. Offer your assistance to your employer in completing the Employer's First Report of Accident form required by your state.
3. Seek medical assistance immediately from the employer's required medical provider [or the suggested medical provider(s)].
4. Obtain from your employer the name and phone number of the adjuster who handle your workers comp claim.
5. Obtain from your adjuster the claim number for your claim and use it on all correspondence, and have it available whenever you contact the adjuster.
6. promptly complete and return all forms provided to you by the adjuster and your employer.
7. Attend all scheduled medical appointments and provide your doctor with accurate information on the nature and scope of your work duties. (WCxKitz)
8. Advise your employer and the adjuster of any changes in your medical status or work status.
9. Do not engage in any physical activities that will slow your recovery.
8 Tips for Insurers and TPAs
Insurers and TPAs speed up the processing of workers comp claims by employing these proactive steps:
1. Tighten up their “Best Practices” to require three-point adjuster contact the same day the accident is reported.
2. When the employee's medical treatment does not require emergency care, the insurer or TPA can bring in the nurse case manager to direct the employee [where permitted] to the best medical provider for the nature of the injury.
3. In non-emergency situations the nurse case manager can discuss with the medical provider the injury and the treatment to be provided prior to the initial medical visit.
4. Utilize a vocational rehabilitator to coordinate between the medical provider, the employer and the prompt return to work of the employee.
5. The adjuster can provide the medical provider with all necessary forms, including blank return-to- work slips prior to the first medical visit.
6. The adoption of electronic data interchange (EDI) can reduce the time for transmission of information between employers, physicians and state workers comp boards.
7. Supervisory reviews by the insurer or the TPA can be done within 14 days of the lost time claim being reported, rather than at 30, 60 or 90 days, or when the claim file reaches a dollar threshold amount.
8. If the nurse case manager or the adjuster has any questions about the medical progress or the medical treatment, a peer-to-peer review (doctor to doctor) should be requested. Ask your TPA if they have a medical director to work closely with you on your claims if you don't have your own medical director. Claims are medical injuries – don't forget that! (WCxKitz)
Summary
Your company will save money when you expedite the workers compensation claim process. Every step you take to report and handle the claim earlier results in lower claim cost. The costs associated with speeding up the claim are minor compared with the costs of allowing the claim to get out of control by moving along at its owns pace.
\Author Rebecca Shafer, J.D. and Consultant, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
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on Monday, July 12th, 2010 at 7:34 pm and is filed under Communication with Employees, Coordinating Medical Care, Management Commitment, Settling WC Claims, TPA and Claims Administration.
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