Members of the claim management teamwork with various service providers that assist in resolving claims. It is vital to develop a relationship with these providers and use them correctly. When done right, a claim handler can reduce program costs and improve the efficiency of a workers’ compensation program.
Use Work Hardening Programs to Return Employees to Work
Work hardening, when appropriately used, can promote a successful return to work. This is something interested stakeholders should consider and not force it to be suggested by the employee’s treating doctor or attorney. Benefits of work hardening include:
- Encouraging employees to overcome psychological barriers and get back to work and their life;
- Allow the employee to overcome the effects of being off work for an extended period – deconditioning – and build endurance and strengthen safely; and
- Promote a willingness to approve appropriate treatment modalities that reduce the need for litigation.
Work hardening programs can also set appropriate restrictions on activity in a manner free of bias.
Independent Medical Examinations – Timings is Key
Interested stakeholders in defense of a workers’ compensation claim need to consider using an independent medical examination to drive matters toward settlement.
- Receive an opinion related to the nature and extent of the work injury. These opinions can also address what, if any, medical care the employee may need;
- Determine if the employee is at maximum medical improvement – and use the report to discontinue wage loss benefits;
- Evaluate if a permanent partial disability rating is applicable so minimal ascertainable permanency can be paid; and
- Examine if the employee is malingering. Opinions of this nature may be used in conjunction with independent vocational evaluations.
Ensure you have a complete set of medical records and a statement from the employee under oath before scheduling the independent medical examination.
Schedule an Independent Vocational Evaluations
An independent vocational evaluation is used to determine the functional ability of an employee. A trained vocational expert performs these evaluations. They will generally issue findings and opinions regarding the following issues:
- Determine the employee’s baseline for functional ability and workability;
- Assess appropriate restrictions on the employee’s activity, and whether the employee is malingering or enhancing their symptomology; and
- Evaluate whether the employee can return to their pre-injury position or other modified jobs.
It is essential to review the credentials and evaluate the vocational expert’s credibility before any evaluation. This expert may be called on to testify at the hearing, so considerations should include their “bedside manner.” It is also essential to write an effective cover letter to this expert to ensure the correct information is given.
Never Forget to Consider Medicare’s Interests
Securing a Medicare Set-aside has become an essential component of many workers’ compensation claims. Many service providers prepare these reports. This complicates the selection of the best service provider. Areas to consider should include:
- Medical: The person who prepares a Medicare Set-aside allocation report should have training and experience in the medical field. Nurses are often used to write these reports, given the attention to detail required.
- Legal: Service providers offering Medicare Secondary Payer services must have trained legal counsel who has practice experience in workers’ compensation claims. An attorney with this background will provide insight on resolving claims and bring creativity to settling the most troublesome cases.
- Financial: Structured settlements are often used as a funding mechanism for Medicare Set-asides. Any service provider who writes the allocation should have access to a financial professional familiar with these products and Medicare Set-asides.
Working with a skilled service provider in this area will allow claim teams to get the peace of mind they need when it comes to these issues.
Other Areas to Consider Service Providers
Several other services members of the claim management team should consider using a service provider.
- Translation Services: These services will promote effective communications between claimants who do not use English as a primary language or have limited use and the claiming team. Using a translator will promote efficiency and goodwill.
- Transportation Services: A work injury often creates financial hardships for employees. Necessary medical appointments are missed due to the inability of the employee to get to the doctor. Being proactive by offering transportation or rideshare services at no cost reduces the opportunity for “missed” medical appointments.
- Retraining Plans: Interested stakeholders should never knee-jerk deny proposed retraining plans. A proposed plan may present an opportunity to understand the employee’s interests and advance settlement negotiations. Other considerations can include looking for less expensive programs that accomplish the shared goal of closing a claim.
The claims management team members face many challenges toward ensuring only the proper benefits are paid. Using service providers requires best practices to ensure that excessive money is not spent on a claim. Now is the time to understand how these providers work and when to use them properly.
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.
Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/
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