Workers' Comp Claim Management From Start to Finish: Important Issues to Consider

Members of the claim management team need to consider several issues during the life of a workers’ compensation claim. The results can be devastating when a missed step or issue is not considered. Now is the time for all claim handlers to evaluate how they handle claims once received and move them toward settlement.

Injury Prevention and Workplace Safety

All members of the claim management team and interested stakeholders should focus on workplace safety. While it is impossible to avoid all work injuries, taking proactive steps can help reduce their frequency and mitigate exposures.

Provide resources to all employer representatives on best practices related to a safe workplace;

Assist in obtaining state-specific signage required under statute or administrative rules for employers and

Provide ongoing training and education related to workplace safety and best practices.

Reducing the frequency of workplace injuries can help improve workers’ compensation programs. It will also drive better workplace morale. Now is the time for claim handlers to get involved in workplace safety.

Assist in Injury Reporting

Countless studies demonstrate that claims reported within 24 hours of the incident shorten the life of a claim, decrease the chances of litigation, and have better results. Claim handlers play a critical role in injury reporting when they work with insureds. There are many roles they can be involved in when it comes to reporting a claim.

Education on how and when to report a claim. This can include what information to include and how to present the information. Employers should be encouraged to report workplace injuries to mitigate their exposure;

Training on what information to collect. Many employers are reporting their first workers’ compensation claim and do not know what information to collect. Failure to obtain the correct information can impede a claim investigation and lead to protracted litigation and

Improve the injury reporting platform. Technology has advanced exponentially over the years. Now is the time to remove the paper-driven system and move to web-based and smartphone technology. These platforms ensure consistency in data and its integrity.

All work injuries need to be reported promptly. Members of the claim management team need to be a part of the process to ensure the information’s accuracy and that it is being reported within 24 hours of the incident.

Directing Medical Care

The claim management team members can help interested stakeholders by offering their insured access to telephone medical triage services. Registered Nurses staff these services to answer medical questions 24/7/365. Implementing these services can help reduce workers’ compensation program costs.

Allows all employees and supervisors to immediate and effective medical assessment following work injury;

Allows supervisors to receive accurate information and reduce unnecessary care such as hospital visits and can assist when applying on-site first aid; and

Allows employers to direct medical care better when additional non-life-threatening medical care is required.

These services should only be used for non-life-threatening work injuries. Always call 911 and assist an employee when their life is in jeopardy.

Emphasis on Return to Work

There needs to be an emphasis on return to work immediately after the employee has been stabilized following a work injury. Employees not engaged in these efforts tend to become deconditioned and have protected time off work. The result is excessive money spent on indemnity benefits and unnecessary work hardening programs.

Establish a return to work coordinator with every insured. Maintain frequent contact with this representative;

Coordinated efforts with the employer to get the employee back to work. This can also include working with a vocational rehabilitation counselor on these efforts; and

Be creative and think outside the box. Consider the Ticket to Work program for employees qualifying for Social Security Disability Insurance benefits or “work on loan” options for others.

Now is the time to emphasize return to work in your workers’ compensation program. The claim management team members can play a vital role in this aspect of all claims.

Driving Claims Toward Settlement

Members of the claim management team should consider moving a claim toward a settlement shortly after intake. This can include many other considerations, such as:

Necessary claims investigation techniques such as surveillance;

Use of an independent medical examination and/or a vocational rehabilitation expert; and

Consideration of a Medicare Set-aside and use of a service provider to consider Medicare’s interests.

Conclusions

There are many vital issues to consider during a claim. The claim handler plays a vital role in issues such as workplace safety and reporting a claim. It is also crucial for the claiming team to be involved in other issues, such as directing medical care and returning to work. Taking the initiative early will allow the claim handler to assist interested stakeholders and drive claims toward settlement.

Michael Stack, CEO of Amaxx LLC, is an expert in 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 employers and ties results to a Critical Metrics Dashboard.

Contact: [email protected].

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

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