12 Steps for Employer Claims Management
In order to manage your claims, employers need to follow these steps.
- Seek outa physician who will really work with you and the goals of your company. Have the HR or safety department meet with the physician. Invite the physician to tour your facility to see the work environment and get a better understanding of the workers job duties. If your company doctor doesn’t provide you with the service you need, get a new one.
- If you seemto have injuries that occur more often in one particular area you might consider a job analysis to see if the environment can be changed to reduce the risk of injury. This is particularly important in repetitive work environments.
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- Make a planfor accidents which occur after normal clinic hours. If you direct your employees to an ER make sure there is a protocol on file with your instructions for care. Many facilities will keep notes on file for things such as your billing information, contact information, instructions for drug or alcohol screens upon injury, referral to certain specialists, etc.
- Once a claimtakes place, report it promptly (24 hour max) and be as detailed as possible about when it occurred, when it was reported, where they were treated and red flag anything that might appears suspicious.
- Attend theappointment with your employee. This shows that you care about them and gives you an opportunity to monitor information the physician receives from the employee as well as the affect the treatment plan will have on the work duties.
- Once you movefrom the company doctor you might want to consider a case manager to attend with the specialist.
- Get detailedinformation about how the employees work might be restricted and discuss goals for light duty and transitional duty. Brainstorm for ideas with the employee too.
- Provide informationabout the workers’ compensation process and benefits to the employee
- Check withemployee to insure that the restricted duty is being followed. Make sure supervisor is keenly aware of what they can and cannot be expected to do.
- If the workermust not work, call them regularly; weekly is ideal. Litigation comes about many times simply because the injured worker feels as if no one cares.
- Hold claimreviews with your insurance carrier and case management (if assigned). Determine estimated length of disability and brainstorm for ideas to help the rehab process.
- Consider a workhardening program for injured workers who have been off for an extended period of time to insure a successful return to work.
These easy tips can result in huge cost savings over the length of a single injury. Despite the cost of the case manager, the negotiation of reduced cost services and the promptness of treatment, and the prevention of unnecessary litigation can offset the NCM expense.
Author: Victoria Powell is the President of VP Medical Consulting, LLC located in Central Arkansas. VP Medical Consulting is a nurse consulting firm providing services to employers, insurance companies, attorneys and the general public. Services include case management, life care planning, legal nurse consulting, ergonomics and patient advocacy. Ms. Powell holds specialty certifications in a variety of nursingspecialties. She can be reached through the web at http://www.vp-medical.com or by phone at 501-778-3378.
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