For the smart man or woman running a business, staying on top of your workers compensation claims is a critical component to success.
As all too many business owners have unfortunately discovered over time, letting your workers comp claims get out of control can lead to excessive expenses, sometimes putting the company budget in the red. In order to avoid this problem, make sure there is a physical review of each and every open and closed claim file. In doing so, this demonstrates the quality of file handling both now and in the past.
For business owners, it is important to choose newer claims along with the old ones; reviewing newer cases allows you a better chance to have an impact on how ultimately the claim will turn out. As an example, when a physician reviewer and experienced claim rep look at files, they can determine as to whether or not the medical care is in fact well-coordinated and ultimately good quality.
Are Strategies Being Implemented and Followed?
The review also provides information on if the strategies towards claims closure have been developed and actually followed. This leads to determining if the time missed from work is relevant to the degree of disability.
The goal at the end of the day for the reviewer is to properly determine whether or not the file handling is proactive or reactive, along with if it is correctly focused on providing a fast closure. Another area to look in on is whether medical bills are looked at for duplicates and compliance with fee schedules.
Leave a file review with a detailed plan of action for each claim. Be sure to assign responsibility and a targeted completion date for each follow-up item. While phone reviews can be done, an actual face-to-face review should always be the preferred method.
Medical Doctor’s Role is Crucial
It should not come as a surprise that the single party oftentimes most missing with a claim review is the MD. He or she is undoubtedly the best individual to address the validity of the injury, the length of time the employee must take off from work, and an approved form of therapy. The medical doctor also should go over whether nurse case management has in fact been properly utilized and ultimately effective.
Unfortunately, many times the NCM is used too late or too early, meaning protocol for usage of the NCM was not integrated with the companies’ post-injury plan. Keep in mind that there are a sizable number of well-qualified and available medical doctors, including those MD’s in the insurance industry.
Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. http://reduceyourworkerscomp.com/about/. 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, attorney, or qualified professional.
