In a recent claim file audit, the auditor was aghast to see a workers compensation claim recently reported on an Acord Form for workers compensation. It had probably been 20 years since the last time the auditor saw a paper report of a workers comp claim being mailed into the claims office. (The Acord Form paper was yellow with age, so the form was at least 20 years old). A small town had properly reported their workers comp claim to the municipal pool but their method of claim reporting was definitely outdated.
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“How Do I Get My Adjusters To Follow My Account Handling Instructions?”
I had the opportunity to visit a “Call Center” recently, and it was very enlightening. There was a well-organized, huge room with rows of open-faced cubiles with a “Command Center” at the front of the room. The “Commander” kept the pace of the intake evenly spread across all coordinators. There was “score board” at the front of the room displaying how many calls are active, how many are waiting, and the average wait time (2 seconds). I highly recommend you visit the intake center for your TPA or carrier. All faxes were automatically converted to email, and put into the queue for almost immediate distribution. It looked like phone calls, faxes, internet submissions and email were all handled within 5 minutes.
There are several ways the employer can report the new workers comp claim to the claims office.
The primary modes are:
1. Internet report form
2. E-mail reporting
3. Fax reporting
4. Telephone reporting
5. Postal Service mail
Internet Reporting
Most insurers and third party administrators (TPA) are promoting the use of the internet to report claims. The goal is to make the reporting of the claim as simple, easy and fast as possible for the employer. The insurer and the TPAs know the sooner the claim is reported, the better the chances of a successful outcome on the claim. The internet report is a fill-in-the-blank format the employer completes. (WCxKit)
The benefits of the internet report is the insurer’s or TPAs’ computer can download the information direct into the claims management computer system saving the insurer or TPA the clerical time of entering the data, plus it eliminates data input errors on their end.
E-Mail Reporting
The transfer of information by e-mail allows the insured/employer to utilize their own form and to send it as an e-mail attachment. While the information is transferred as fast as internet reporting, it is necessary for a clerical person in the claims office to print the report and type the information into the claims management system. Some insurers and TPAs are providing the employers with a copy of their internet report format for emailing. This still allows the insurers and TPAs to transfer the information directly into the claims management system without using the services of clerical staff.
Fax Reporting
Twenty-five to thirty years ago fax reporting of the workers comp claims replaced mail reporting of workers comp claims. It allowed the employer to get the claims report to the claims office in a minimal amount of time. The claims office staff would then take the claims report and manually enter all the information into the claims management computer system.
Telephone Reporting
Telephone reporting requires the employer to call the claims office and give each line of information to the claims’ office personnel who either write it down on a paper claim reporting form or enter it directly into their claim management computer system.
Telephone reporting is still often used in emergency situations and when accidents occur during evening or night hours when the claims office is not open. The insurers and TPAs have a call-center to accept telephone reports on a 24/7/365 basis. The process is still the same with the claims office inputting all the information into the claims management computer system.
If you will have situations where the workers comp claim needs to be reported immediately by telephone, the following is some of the information your personnel should have handy when calling in a telephone report of a workers comp claim:
1. Workers comp policy number and effective dates.
2. Employer’s name and address plus location code or department number or any other internal means of identifying used by the employer.
3. Employee’s name, age, sex, address, e-mail address, telephone numbers and social security number.
4. Date, time, and description of the accident.
5. Witnesses’ names and contact information.
6. Type of injury and body part.
7. Name, address and phone number of medical provider.
8. Information on whether or not the employee has returned to work or has a return to work date in the near future.
9. Wage or salary information on the employee.
Mail Reporting
Mail reporting has almost been totally eliminated by telephones, fax machines and computers. It entails the employer completing a workers compensation claims report and mailing it to the claims office, where the clerical staff of the claims office enters the information into the claims management system. The problem with the insured reporting the claim by mail is the additional time it takes for the claim report form to travel through the mail, then to be opened, date stamped and the information entered into the computer system. (WCxKit)
Legalities
Most states now require the employer to keep a record of all workers comp claims. A few states have placed time restrictions on how long the employer can take to report a claim. Some of the states require a copy of the workers comp claim report to be filed with their workers compensation board or industrial commission. All states impose penalties on employers who fail to report workers comp claims. A few states have started requiring all claim reports be on their own state First Report of Injury Form. The insurers and TPAs are adapting their computer systems to accept the First Report of Injury Forms via the internet and e-mail.
Summary
Regardless of the mode the claim is reported, it is essential for the claim to be reported as fast as possible following the accident. Various studies show the shorter the time between the moment of the accident and the claims adjuster contacting the employee, the better the overall outcome of the claim.
Author Rebecca Shafer, J.D., 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: [email protected] or 860-553-6604.
WC Books: http://www.LowerWC.com/workers-comp-books-manuals.php
WC Calculator: http://www.LowerWC.com/calculator.php
TD Calculator: http://www.LowerWC.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
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