Learn One Excellent Method to Stay On Top of Workers Comp Claims

King Arthur is often credited with creating the roundtable discussion concept where various parties with different points of view were brought together to discuss an issue and to obtain consensus on how they should proceed. In the modern day of world of workers compensation claims administration, the roundtable concept is often used within the claims office where the work comp adjuster, the supervisor, the nurse case manager and possibly others sat down together and discuss the best approach to take on a difficult or complex claim.

 

 

As the employer, you should request to be included in the roundtable discussions of your more serious workers compensation claims. The roundtable discussion provides a forum where the members of the roundtable can provide input that will benefit everyone involved. (WCxKit)

 

 

Whether you want to have a roundtable discussion on a weekly basis or a monthly basis will depend on the number and complexity of your work comp claims. Once you have agreed with the claims office on when you will have the roundtable discussion, be prepared for it. Please remember the roundtable discussion is for the purpose of fostering approaches to moving the work comp claim forward, not to educate you about the claim. The fastest way to end the roundtable discussion practice is for you as the employer to join the discussion unprepared. If you have to ask the nature of the employee's injury, when the last doctor's visit was, or what the impairment rating is, you will be perceived as not involved. The purpose of the roundtable discussion is to advance the claim, not to answer basic questions you should already know.

 

 

You will need to know beforehand the participants in the roundtable discussion. Beside your participation, do you want others from your company involved? Would it be beneficial to have the workers compensation claims coordinator involved? The risk manager? The employer's claims manager? Someone else? You will also need to know who from the claims office will be participating. Will it include the nurse case manager, the adjuster, the supervisor, the claims manager? Will defense counsel be participating?

 

 

In a roundtable discussion is does not hurt to have a moderator who keeps the discussion on point and makes sure everyone contributes. Other than that, the roundtable discussions are generally free flowing without a formal structure on who can speak and/or when someone will speak. The agenda can be loosely defined as the list of claim files to be reviewed.

 

 

To be prepared for the roundtable discussion, you should thoroughly familiarize yourself with the claim(s) to be discussed. This means accessing the carrier's or TPA's claim management system and reading all the claim file notes, all of the medical reports and all of the defense attorney's reports beforehand. It is okay to ask questions in the roundtable discussion that are not answered by the claim file, as those are often the issues holding back the progress of the claim.  

 

 

Be ready to share your concerns, thoughts, suggestions and recommendations about the claim. Also, be ready to listen to the ideas, suggestions and remarks of the other roundtable participants, keeping in mind that the claims adjuster, claims supervisor and the other involved in the roundtable specialize in workers compensation claims. A quick way to end the roundtable discussion practice is to mandate your approach to the claim is the only approach that can be followed.

 

 

In the roundtable discussion, the participants often share experiences they have had in similar situations and relate how their prior experience can affect the outcome in the present claim under discussion. When several members share approaches that have worked in the past, the members of the roundtable can compare the different approaches and select the method they think will work best in the present situation with the claim being discussed. Decisions should be made by consensus of the roundtable members. (WCxKit)

 

 

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