Interested stakeholders in the workers’ compensation claims process need to focus on relationships and developing them to succeed in their program. These relationships allow everyone to gain trust and confidence and develop ideas. It can also help reduce workers’ compensation program costs and drive claims toward settlement. Now is the time to evaluate the relations within your program and take steps to develop them
Injury Management Partners Drive Success
It goes without saying that the success of a claim and resolving it effectively and timely start with actions taken at the time of injury. Timely reporting of work injuries requires employers to get accurate claim information in the correct format. Problems often arise when these two stakeholders are not on the same page. This is often the result of the employer and claim team not having a good relationship.
Now is the time for employers to develop a relationship with the claims team. Steps that can be taken today include:
- Set up an in-person meeting or Zoom meeting to get to know each other. This meeting can exchange ideas and set expectations for each stakeholder.
- Exchange complete contact information. This should include name, job title, direct dial, and email address. Employer representatives should also consider providing cellphone information that will facilitate quicker access; and
- Set expectations regarding return to work policies and procedures. This requires each site to understand essential processes and procedures.
Employers can also consider other bridge-building activities. This can include a “vendor day” where service providers who work with the employer can visit their workplace locations to understand its mission better.
Review and Revise Account Handling Instructions
Employers also need to take immediate action to review the claim handling instructions – and continue to review them regularly. These instructions are important because they provide direction from the claim management team on how to manage claims. Issues to clarify include:
- Selection of defense counsel and the composition of the attorney panel;
- Clarification on doctors to be used for purposes of independent medical examinations;
- When and how to consider and/or use structured settlements in claim resolution; and
- Service providers to use for Medicare Secondary Payer compliance and the preparation of Medicare Set-asides.
This is not a complete list of items to consider as there are many different considerations in instructions for the claims team.
Set and Conduct Regular File Reviews
File reviews are an excellent opportunity for employers to discuss issues in detail with a claim handler (and possibly defense counsel) and develop plans for effective resolution. The
There are countless benefits of holding regular file reviews. Some of the benefits include:
- Develop a better level of comfort between the insured and insurer;
- Set the framework for priorities on what claim(s) take priority;
- Encourage the exchange of ideas that leads to creativity; and
- Helps keep reserves set at an appropriate level.
The bottom line is that file review can improve efficiency and drive claims toward a settlement when done correctly. This can also include driving better communication between all interested stakeholders. Now is the time to consider holding file reviews.
Develop Relationships with Health Care Providers
All interested stakeholders can reduce workers’ compensation program costs by establishing relationships with healthcare providers. This proactive step increases the quality of medical received by the employee following a work injury and promotes the return to work.
Brides can be built with health care providers by taking the following steps:
- Employers can establish a network of healthcare providers where employees can go following a work injury. This decision should be driven by data and analytics that evaluate the quality of care at a facility/network;
- Use nurse case managers who know how to best communicate with doctors at healthcare facilities. Issues such as the direction of medical care and restrictions are vital areas; and
- Using a trial and error approach determines if the data reviewed matches the results.
Interested stakeholders can take many steps to develop relationships within the workers’ compensation claims process. This requires employers to evaluate their service providers and better manage the claims process with the claims team. They should also review account handling instructions and meet with the claims team to review files. Insurance carriers and employers should also find the best-in-class provider network. When implemented effectively, stakeholders can reduce the costs of claims and reach a better result.
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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