Leaders of claim management teams are constantly seeking solutions to solve problems. This includes surrounding themselves with like-minded individuals who have a mindset that empathizes with the injured worker while at the same time advocating for the bottom line. When seeking to accomplish this goal, interested stakeholders should evaluate their program and settlement procedures. Another area of focus should include the development of relationships with defense attorneys that share the same vision as the claims management team.
Evaluate Cases Early and Attempt to Settle
All members of the workers’ compensation claim management team needs to develop the skill of evaluating a case and driving it toward timely settlement. This involves several steps that need to be taken before referring a case for legal assistance. Necessary steps include:
- Conducting an effective initial investigation and, if necessary, issuing a denial of primary liability grounded in the facts of the claim and the law. Failure to do so in a timely manner will only add to the cost of each claim;
- Accurately calculate the average weekly wage (AWW) to determine properly the employee’s benefits and future exposure. Most workers’ compensation benefits are grounded in the AWW. Failure to calculate it correctly can significantly increase the time and money spent on a clam; and
- Obtain the necessary background information on the claimant and work injury. In many instances, even seasoned claim handlers are not able to settle a case given their lackluster efforts in doing basic research on a claim.
Identify Defense Counsel with Similar Values
Members of the claims management team need to expand their horizons and continually develop relationships with members of the defense bar. This investigation needs to go beyond where an attorney went to law school or the name of their law firm.
- Build relationships: There are countless opportunities to meet defense attorneys. This can include bar association functions, claims association meetings or involvement in community programs. Claim handlers serious about seeking creative solutions need to be proactive when it comes to finding the right attorney. A factor should not include who is offering a free lunch or tickets to the big game.
- Ideals Consistent with Your Program: Part of getting to know a defense attorney needs to go beyond that person’s favorite restaurant. Members of the claims management team who want to find the best fit for their program need to understand the defense attorney’s strengths, opportunities to become a better lawyer and their views on how to handle claim.
Claim Updates and Consistent Status Reporting
Knowing what is going on in a case is important for anyone involved in handling workers’ compensation claim. This is due to the speed at which claims are handled, litigated and moved toward final resolution. Effective claim handlers need to seek out attorneys dedicated to keeping them involved and apprised of claim developments.
- One effective tool to do this is a status report. A typical status report should include information on the facts of the case, a clear and concise legal analysis and proactive recommendations for further handling. There should be no surprises. This includes matters concerning case evaluation, the exposure of a claim and what likely will happen.
Running an effective claims management team and handling individual claims is demanding work. This requires the individual claim handler to be proactive in the early part of a case as they investigate the injury and make determinations regarding liability. Another important point is for claim handlers to develop relationships with attorneys to drive claims to settlement.
Author Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .
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