Myth: Our Claim Reviews Keep Us in Control

“We review every open claim, so we’re in control.” It is one of the most common things employers say about their workers’ comp program, and it sounds right. The adjuster is on the call. The nurse case manager is on the call. HR and safety are there. Every claim gets discussed.

Now look at what most of those meetings produce. A status update on each claim. A reserve that moved. The next appointment date. Then everyone hangs up, and the following week the same kinds of injuries come in the same way.

Why it is a myth

A claim review looks backward, at claims that already exist. Control is about what happens on the next injury, before it ever becomes a claim. A review that only reports status is a reporting meeting. It tells you where things stand. It does not change what any supervisor does tomorrow morning.

The test is short: a review only counts if something changes. If you cannot name the decision your last review produced, who owns it and when it is due, the meeting was an update, not control.

What to look at instead

Take your last three reviews and ask:

• Did any claim come up because of how it started, not just where it stands? A late report, no call on the first day, no transitional duty offer.
• Did the meeting produce a change outside the claim file, to a supervisor, a location or a process?
• Does that change have an owner and a date, and did anyone check whether it happened?
• Are the same locations showing up again?

If most of the answers are no, your reviews are doing what they were built to do, which is keep the claims moving. They were never built to keep the program under control. That takes a short weekly look at how every new injury was handled at the front end, with the misses assigned and followed up. It is also why reviewing claims only once a quarter leaves so much unseen.

Michael Stack is CEO of Amaxx, which installs Injury Management Operating Systems (IMOS) for employers: one defined injury response process, clear supervisor expectations, return to work structure, a weekly scorecard and an operating rhythm that keeps it from drifting. For more than 30 years, Amaxx has helped employers take control of how injuries are handled across every supervisor, department and location.

Contact: mstack@reduceyourworkerscomp.com

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