We all know the time from the moment of injury to final resolution can be lengthy. A competent business manages the process in an organized manner by monitoring all claims to ensure adjusters start working the claim as soon as it is reported.
Clearly define the role of your adjuster and injury coordinator to ensure a delineation between the roles. The injury coordinator provides input into overall “big picture” strategy on claims. Adjusters determine compensability pursuant to state law on individual claims.
9 Ideas for Managing Ongoing Workers’ Comp Claims
1. Adjusters must contact the employee, the employer, and the doctor immediately after the work-related incident occurs. Don’t let the process manage you, YOU should set up the injury protocol and manage each step of the process.
2. Medical restrictionsfor modified work MUST be obtained on the FIRST medical visit. These are useful not only for modified duty placements, but also for adjusters, medical directors and nurse case managers to gauge improvement. Initial restrictions are a baseline for improvement determinations.
3. Adjusters must ensure the employee receives medical treatment and medication. Some TPAs have triage nurse that are contacted immediately after the injury to help determine whether self-care or provider care is appropriate. They use sophisticated protocols to help determine whether the injury needs to be treated NOW (call 911), in 6 hours, 12 hours, or put heat on the injury, let it rest and go back to work later today.
4. Adjusters must notify injury coordinator if the employee misses medical appointments. Some TPAs will call the employee before the medical appointment to make sure they remember the appointment, have the employer’s paperwork and there are no obstacles to getting to the medical appointment. Remember, not all people have reliable transportation, and do not own cars. When injured, transporation may be a problem.
5. If the injury is questionable, adjusters must assign investigation to the incident and immediately discuss this with the injury coordinator. The minute red flags are seen in the claim, investigation should be considered.
6. Adjusters should assist in determining which transitional jobs best accommodate the physical limitations of injured employees, by facilitating communication between employee, employer, adjuster and medical provider. Employer SHOULD take the lead in some cases, however if they don’t, the adjuster can take the initiative.
7. Visit a claims’ handling office at least once a year to view claims handling and to develop a rapport with the adjuster. Sit “chair-side” for an afternoon – you’ll be amazed at how much you learn.
8. Invite the adjuster to visit your facility to meet you, to learn job categories and physical demands of the jobs, and to observe or discuss transitional duty jobs. Include lunch!
9. Get a Plan of Action that is detailed about what steps are required to get the employee back to pre-injury condition. “Get employee back to work” is not a sufficient POA! After every roundtable or file review meeting, the POA should be distributed to each party for monitoring and follow-up.
Author: Rebecca Shafer, J.D. designs and develops workers’ compensation cost containment programs, and is the developer or Workers’ Comp Kit®, an on-line automated tool kit with an assessment, benchmarking and improvement plan. Rebecca can be contacted at: 860-553-6604 and email: RShafer@ReduceYourWorkersComp.com http://www.ReduceYourWorkersComp.com.
