How to Test Every Line of Your Account Handling Instructions

The first question usually gets the most attention. Replacing “we support return to work” with “modified duty will be offered within 24 hours of receiving work restrictions” turns a philosophy into a decision. A decision alone isn’t enough, though. The other three questions are what make it usable in practice.

Triggers: When This Happens, Do That

A trigger is a clear event in the life of a claim that starts a specific action.

Workers’ compensation claims follow predictable patterns:

• Indemnity benefits continue past a certain number of days.
• Costs cross dollar thresholds.
• Surgery is recommended.
• An attorney letter arrives.
• The employee stops attending appointments.

Each of these is a mile marker. Instructions are much easier to follow when they’re tied to mile markers rather than general expectations.

Compare these examples:

• Weak: “Complex claims should receive additional attention.”
• Strong: “If indemnity benefits extend beyond 14 days, schedule a claim review with the employer’s workers’ comp coordinator.”
• Weak: “Surgical cases should be monitored closely.”
• Strong: “Upon receipt of a surgery recommendation, notify the employer and evaluate the need for a nurse case management referral.”

The adjuster doesn’t have to decide whether a claim is “complex.” The trigger decides for them. When you review your instructions, look for words like significant, complex, appropriate, or as needed. Each one usually signals a missing trigger.

Timelines: How Quickly It Must Happen

A trigger without a timeline still leaves room for delay.

“Contact the employer when surgery is recommended” is better than nothing. “Contact the employer within one business day of a surgery recommendation” is something an adjuster can plan around and something you can measure.

The most familiar example already appears in nearly every set of instructions: three-point contact with the employer, the injured employee, and the medical provider within 24 hours. It works because the expectation is specific.

Apply that same standard elsewhere:

• Response time for emails and phone calls
• Filing of required state forms
• Initial reserve setting
• Referral to nurse case management after a defined trigger
• Follow-up after a return-to-work release

Timelines also make accountability fair. When expectations are specific, a review conversation becomes objective. Either the standard was met or it wasn’t. No one has to argue about what “promptly” was supposed to mean.

Notification: Who Needs to Know

The fourth question is where many instructions break down.

“The employer must be kept informed” sounds reasonable. In practice, it tells the adjuster almost nothing. Informed about what? By whom? Before or after the action?

Here’s a stronger version: “The risk manager must approve any reserve increase that would bring total reserves above $50,000 before the change is made.”

That one sentence contains a threshold, a timing requirement, and a named role. Your dollar amount will differ, but the structure is what matters.

Notification instructions should answer:

• Which role must be contacted, by title and name
• Whether notice comes before or after the action
• Whether the contact is informational or requires approval
• Who the backup is when the primary contact is unavailable

That last point deserves attention. An approval requirement is only as good as the person responsible for approving. If the adjuster needs your sign-off and can’t reach you, the instruction creates delay instead of control. Delayed claims tend to stay open longer, and longer claims cost more.

Putting the Four Questions to Work

You don’t need to rewrite your instructions from scratch. Start with the version you have now. Take each instruction and ask the four questions. Where an answer is missing, add it. Where an instruction relies on vague language, replace it with a specific trigger or timeline.

Many employers find they can keep their existing philosophy almost entirely intact. They simply make it clearer, more concise, and easier to act on. Then share the revised version with your claims partner. Ask the adjusters handling your files where they get stuck. They often know exactly which instructions cause confusion.

Final Thoughts

Adjusters follow the instructions that are easiest to follow. Every trigger, timeline, and notification rule you define removes one more decision they would otherwise have to make on their own.

That is how account handling instructions stop sitting in a file and start shaping how your claims are actually handled.

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: mstack@reduceyourworkerscomp.com.

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

Injury Management Results (IMR) Software: https://imrsoftware.com/

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