When is the best time to settle a workers’ compensation case? The answer that should come to mind for every proactive member of the claim management team is – RIGHT NOW! Sadly, some members of the claim management team avoid early chances to settle claims. The result of delaying settlement is paying extended wage loss and medical benefits.
Avoid Common Tactics that Limit Settlement Opportunities
Workers’ compensation claims are, by their very nature, emotionally based on the adversarial nature of the business. If a claim is denied in whole or in part, the employee often takes the decision personally. While you cannot please everyone, problems often arise when claim teams employ tactics that place barriers to settlement:
- Delay: This comes in many forms. Medical care is denied, and then an independent medical examination is scheduled out of the blue. In some instances, the result is predetermined. A medical expert known to give the “bought and paid for” report is selected. Delay comes in other more subtle forms. Phone calls are not promptly returned. Paperwork that is submitted gets “misplaced.” Even if this is not the intention, the employee suffering from a work injury will view this as a negative tactic being used to grind things out.
- Diminish: Most commonly this comes in the form of denying a portion of the medical care being requested by the employee such as a second opinion, change in treating doctor to someone specializing in a particular body part or treatment modality, telling the employee not to hire an attorney, or promoting vexatious litigation to “scare” the employee into settling. These tactics simply do not work and often backfire.
- Denigrate: This also comes in many forms. Most commonly, it comes in comments made by the claim handler in terms of medical care being performed by a chiropractor, osteopath, or others specializing in alternative medicine. Remember, the standard is often whether medical care is “reasonable and necessary” to cure and relieve the effects of the work injury. If the employee demonstrates the care is providing subjective and objective relief, it will more often than not be found to be compensable.
- Deny: Studies demonstrate that an increasing number of claims completely denied at the onset of a claim are later picked up by the insurance carrier. The main driver in this trend is claim teams that seek to “deny, deny, deny.” While a denial may very well be supported by some facts present, it should not be the default when reviewing an initial claim, or whether to approve ongoing medical care and treatment.
- Demand: Never make an unreasonable demand of an injured employee. Every employee should be treated with respect and dignity. Failure to buy goodwill at the onset of a claim will only lead to ongoing disputes, bad blood, and needless litigation.
Moving Claims Toward Settlement
Effective claim resolution starts with treating the injured employee as the “VIP” of the workers’ compensation system. Doing easy things can set the right tone:
- Ensure the employee received immediate and effective medical care;
- Follow-up with the employee and provide them with information on the workers’ compensation system, and tips for keeping all the information they receive in an organized manner;
- Provide the employee with the contact information they will need and use – especially the name of the claim handler, and that person’s direct dial; and email; and
- Return calls in a timely manner, and ensure a response is provided in plain English. It is okay to include legal terms, but make sure those terms are explained.
Sometimes getting the settlement process started can be a significant barrier. Questions about whether the case is properly positioned, whether the other party wants to settle a claim or being unprepared lead to a claim dragging on. A majority of the time, members of the claim management team are ready to settle—they are just too afraid to ask.
Picking up the telephone or sending an email to the claimant or their attorney can be a barrier. Now is the time to get ready to start settlement discussions.
Never pass up the chance to settle a workers’ compensation case. Steps to take include evaluating your claims, understanding your strengths and weaknesses, and seeking to settle the claim. What are you waiting for? Pick up the phone, call, and try and settle that claim today.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a 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 the founder & lead trainer of Amaxx Workers’ Comp Training Center , which offers the Certified Master of Workers’ Compensation national designation.
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