Medical costs continue to account for a significant portion of every workers’ compensation claim. In order to address this matter, innovative teams are seeking improvements in the way they direct medical care and treatment in their claims.
Barriers in Directing Medical Care
All workers’ compensation programs are subject to a rigid statutory and regulatory framework that impacts the medical portion of every claim. Notwithstanding the use of treatment parameters and fee schedules, the medical component in every jurisdiction can create challenges. Some common barriers faced by the claim management team include:
- Choice of medical providers and the ability of the employee to switch providers during the course of medical treatment;
- Failure to use correctly an independent medical examination (IME) to mitigate exposure on a claim. This can often include selecting a doctor who lacks the correct credentials or familiarity with the injury in the claim; and
- Problems dealing with medical care that enables the injured worker to malinger.
Dealing with Common Pitfalls in Medical Care
The claim handler in charge of the claim is on the front lines when it comes to dealing with injured workers and making sure they receive the benefits, care, and treatment they are entitled to post-injury. This requires that members of the claim management team take a proactive approach to deal with these issues and reduce future exposures.
Here are some important things to consider:
- Educate the employer/clients regarding injury prevention;
- Be proactive when it comes to reporting claims. Time is of the essence. A promote injury response can also buy goodwill from the employee and their attorney;
- Have good lines of communication with the medical representatives of the employer. This should include having a coordinated response immediately post-injury and continue throughout the course of care; and
- Gain the trust of all medical providers outside the scope of the preferred employer medical team’s network. This includes conducting yourself in a professional manner at all times. By gaining their trust, you will more likely than not gain their cooperation.
The Human Element of Workers’ Compensation
To the injured workers, members of the claim management team are often faceless individuals that are guardians of the insurance carrier’s financial interests. This perception leads to the false conclusion by injured parties and their family members that the claim handler does not consider the interests of the injured employee. Personalizing the services you provide can pay dividends during the course of managing the claim.
Various steps can be taken to gain the trust and cooperation and “humanize” the workers’ compensation process:
- Provide accurate information whenever dealing with the injured party or their legal representatives;
- Be responsive to their communications. Set realistic and reasonable expectations from the outset of the claim. Develop the relationship as you would any other professional interaction. Personalizing the response is helpful; and
- Empathize with the position of the injured party. Although workers’ compensation wage loss benefits are tax-free, they are being paid at a reduced rate. When the injured person is off work, it is important to remember their bills do not have a similar reduction.
Reducing the medical costs in workers’ compensation claims requires an active role by all members of the claim management team. Part of this requires individual claim handlers to make the extra effort in their file load. It is also necessary for the claim handlers to bring a sense of humanity to their claims when dealing with injured employees.
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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