Claim offices frequently employ a technique known as individual file conferences where the adjuster and the supervisor set aside a specific time to discuss one or more large, serious and/or catastrophic claims. Frequently the workers’ compensation adjuster and supervisor will expand their claim file discussion to include the claims manager, other supervisors, other adjusters and the employer.
Employer Should Stay Involved On Claims
The employer should designate a representative, whether the workers’ compensation coordinator, or another person, to participate in the individual file conferences. This accomplishes two things. First, it allows the employer to be up to date on the status of their claims; particularly large, serious or catastrophic claims. Second, in the states where employer input is allowed, the employer can offer insights or recommendations on bringing the employee back to work.
The discussion coordinator, whether the adjuster or supervisor, designates or selects the particular workers’ compensation claim(s) to be reviewed. While the expected cost of a claim can be a reason for a claim to be selected for review, claim cost is not normally the basis for an individual file conference. The claim(s) chosen for discussion are selected based on the obstacles the adjuster has encountered in moving the claim forward. This can include issues of medical necessity, delayed return to work, narcotic addiction, hearing issues, etc. If more than one claim is included in the discussion, each file is discussed separately and independently of other claim(s).
The organizer of the individual file conference will set a date and time for the discussion. Prior to the electronic age, the group would sit around a conference room table to discuss the claim. Now days, the “group” may be in several separate locations and attend the conference by telephone, Skype, webinars or other electronic means.
Provides Additional Perspective On How To Handle Claim
The purpose of individual file conferences is to provide the claims handler with additional perspectives and thoughts on how to deal with an issue. Adjusters, like all other people, develop ways of doing things. Falling into a claim handling rut, where ever claim is handled similarly, can limit the adjuster’s field of vision on what to do on a particular claim.
The individual file conferences by providing other points of view improve the potential outcomes of the claim. The individual file conferences can be an extremely beneficial learning experience for the newer adjusters, but also provides “why didn’t I think of that” moments for even the seasoned old pros.
At each individual file conference, the adjuster keeps a list of the suggestions and recommendations made to move the workers’ compensation claim forward. The list of suggestions and recommendations can be incorporated into the adjuster’s diary of issues and activities that need to be addressed or completed on each file.
For individual file conferences to be productive and not a waste of time for the participants besides the adjuster, the adjuster on the claim file should be prepared to discuss each individual claim. This includes having an outline of the issues to be discussed that are preventing the claim from moving forward at the normal pace.
File Conferences Are About Moving The Claim Forward
Employer participation in individual file conferences is not an opportunity for the employer to learn about the history of a claim from day one. As an employer if you are going to participate in the individual file conferences, you need to have kept abreast of the claim throughout the history of the claim. The individual file conference is about moving the claim forward to the conclusion. It is not about educating the employer.
While the employer should not waste the other participants time getting up to date on the file, the employer should also insist the discussion remain focused on the particular claim issues at hand and not allow the discussion to drift off on to unrelated issues or other claims.
Individual file conferences should be scheduled as needed as only a truly bad claim would entail having an on-going schedule of dates to discuss it. This does not mean that individual file conferences cannot be set on a schedule (example: second Tuesday of the month, 2 p.m.). If a preset schedule is used, the claims to be discussed each date should be changed, and the individual file conference cancelled if there is not a claim that needs the extra attention that the individual file conference provides.
Different Perspectives Can Be Invaluable to Resolving a Claim
Individual file conferences can result in the claim taking a turn the workers’ compensation adjuster did not foresee prior to the file conference. The perspectives provided by other participants can be invaluable to resolving the claim. However, if the same participants are in all the file conferences, the value of the input will decline over time as the adjusters learn what the other participants will suggest. For this reason, in large claim offices the participants beyond the adjuster, the supervisor and the employer should be changed constantly. In the small claim offices, the adjuster can invite a nurse case manager, defense counsel, work comp judges, plaintiff attorneys (not related to the claim) and others to participate in the discussion.
Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: [email protected].
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