WC Cost Containment For The Claims Management Team

The workers’ compensation claim management team is charged with numerous responsibilities. One of the more important functions is to ensure the claim is being properly managed with the containment of wage loss and other indemnity benefits. This multi-factored process requires skill and dedication from all team members.

Independent Medical Examinations and Other Experts

The use of the independent medical examination (IME) is usually the sole opportunity the employer/insurer has to defend a claim with a medical expert of their choice. This is a right governed by the pertinent workers’ compensation act and must fit into specific parameters. Some of the more important guidelines include:

• Distance an employee can be required to travel for the evaluation;
• Reimbursements that must be made prior to or immediately after the examination; and
• Timing of the evaluation and service/filing requirements of the report.

Not every case will require an IME, so it is important to properly evaluate the case and make sure all pertinent documents are received prior to scheduling the evaluation.

Use of Vocational Experts

Other vocational experts often are used when evaluating an employee for return to work, work hardening, job search efforts and retraining. They can also be used when the employee claims entitlement to permanent total disability (PTD) benefits. Laws regarding the use of vocational experts vary and may be subject to other statutory or regulatory guidelines. Before scheduling a vocational examination, it is important to check into the following matters:

• The qualifications, training, and expertise of a vocational expert;
• Investigation into the claims being made by the injured worker and whether such an evaluation is ripe for additional scrutiny; and
• The ability of the vocational expert to give credible live courtroom testimony, if permitted.

The use of a Functional Capacity Evaluation (FCE) is also important. A FCE is defined by some as a “set of tests, practices and observations that are combined to determine the ability of the evaluated to function in a variety of circumstances, most often employment, in an objective manner.”

During an FCE, the injured party will typically meet with a neutral vocational expert or one chosen by the employer/insurer and perform a series of tests. This can include written tests to measure the claimant’s cognitive and educational functions. In other parts of an FCE, the employee will undergo a battery of physical tests to assess the appropriateness of work restrictions in place by medical doctors and evaluate their ability for participation in work hardening, retraining or other rehabilitation efforts.

Telephonic Case Management or Intervention

Changes in technology are creating new opportunities to reduce the costs of managing a workers’ compensation claim. Due to the increase in accessibility of technology, claim management teams can reduce costs of handling claims. While some laws have been slow to adapt, technology will continue to evolve for how claims professionals can provide injured claimants with the care they deserve while efficiently managing costs.

Conclusions

Claims management teams seeking efficiency need to evaluate their programs and adapt to changing times in order to remain competitive. These changes can be made without sacrificing the rights of injured workers.

Michael Stack, CEO of Amaxx LLC, is an expert workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employer and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.