One of the more colorful phrases you will hear in the workers compensation claims office is the term “old dogs”. “Old dogs” is a term referring to the large, old paper files that have been around for years. There are two explanations where the term “old dogs” came from. The first explanation is: As the years went by, the corners of the paper file and some of the papers in the file got the corners bent over, the file became dog-eared. The second explanation is: the claim file is like a dog. During the early start of the claim, it can be very active and things happen quickly like a puppy jumping around. But after a few years, the file, like an old dog, just lays around with nothing happening. (And yes, electronic files can become an ‘old dog’ too, if they hang around long enough).
The primary reason a claim file becomes an old dog file is a lack of aggressive attention to the file by the work comp adjuster. This is not saying the adjuster did not do a good job on the file. The adjuster may have done a great investigation and made several efforts to move the file forward. What happens is the adjuster gets new claims in on a regular basis that need immediate attention, while the file that is becoming an old dog file has nothing happening at the moment. Therefore the adjuster’s attention is on the new claims and not the claim she has for a couple of years or more.
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2. If the state is a jurisdiction where the number of IMEs is limited, a peer review of the medical records can be requested from a medical specialist. The peer review doctor can advise the adjuster as to the appropriateness of the medical treatment and the expected time frame (if any) for the medical treatment to be completed.
3. Any claim more than a year old, or older, with on-going medical treatment, that does not have a Nurse Case Manager (NCM) assigned to the claim should have a NCM assigned. The NCM can assist the employee and the medical provider in coordinating the best possible medical care while expediting the medical treatment. [Note – If the employee is known to have a serious injury at the time the claim is reported to the claims office, medical management with a nurse case manager should be started at the time the claim is received. When medical management is started timely, the possibility of the claim every becoming an “old”dog” is significantly reduced].
4. If the issue on the claim becomes the ability of the employee to return to work, a vocational rehabilitation expert should be brought in to the claim as soon as it is mentioned that the employee might not be able to return to the previous job. The voc rehab expert will work with the employer and the medical provider on ways to place the employee with a permanent partial disability back at work. The vocational rehab expert can work out the details of what the employee will be able to do and the details of what the employer needs to do to be in compliance with the Americans with Disabilities Act (ADA).
5. A detailed review of the file by the claims supervisor or the claims manager should be completed to see if there are options available on the claim that the adjuster has missed. [Where this is a routine practice in the claims office, many claims that could become and old dog claim never get to be an old dog.] If the claims supervisor and claims manager are both too busy to give the old dog files this type of attention, an independent claims auditor should be brought in to review the files and make recommendations on how to move the old dog file forward to the conclusion.
6. An old fashion round table discussion between the claims adjuster, the claims supervisor or the claims manager, and a couple of senior work comp adjusters is often a good way to identify steps that can be taken to move the old dog file. [The old adage: “Two heads (or more) are better than one.”] By bringing other work comp experts into the discussion of the file, the claims adjuster may come up with new ideas to resolve the claim.
7. A source of information that the adjuster often does not think about if the work comp claim is not being contested is the defense attorney that normally handles the contested claims. The defense attorney is often willing to take an assignment to review an old dog claim and to make recommendations on how to bring the claim to a conclusion.
Old dog claims can be difficult to resolve, but most of them can be concluded if a proactive and aggressive approach to doing so is taken. The individual recommendations above should be combined with as many of the other recommendations as needed to resolve the claim.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and Website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. www.LowerWC.com Contact: [email protected] .
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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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