First Report of Injury Accuracy Critical for Workers Comp Success

March 4, 2013 by Leave a Comment

Delegating First Report of Injury Can Create Problems

 

Risk managers and workers’ compensation managers normally delegate the job of filling out the First Report of Injury form (also known in some states as the Employer’s First Report). Delegation of the First Report of Injury to someone who is not extremely careful create numerous problems. All the information on the First Report of Injury needs to be checked carefully before it is submitted to the claims office and to the state Workers’ Compensation Commission / Department of Labor / Industrial Commission / etc. For this article we will use Workers’ Compensation Commission (WCC) for all the states.

 

The First Report of Injury form is usually given the number 1 in most states, whether it is known as the WC-1, DWC-1, or other nomenclature. The reason the form is given numeral 1 is because normally it is the first form for both the WCC and the claims office. The information and data used by both the WCC and the claims office in setting up their files is taken from the First Report of Injury. Little errors on the First Report of Injury are copied and can create havoc.

 

 

Ensure Important Details are Correct

 

Name Spelled Correctly

The spelling of the employee’s name should be checked. If the last name is misspelled by the employer’s representative completing the First Report of Injury, the WCC will copy it verbatim. When the WCC receives medical information or other state forms which they are unable to match to an existing claim, the WCC will inquire as to why the claim has not been reported, as they could not find the work comp claim in their database.

 

 

 

Correct Social Security Number

An employer should never submit a First Report of Injury without the correct social security number (SS#). Too often when the SS# is not readily available, the employer’s representative will use a fake SS# such as 123-45-6789 or 000-00-0000 or 999-99-9999. This may get the First Report of Injury off the desk of the employer’s representative, but it creates issues for the employer, the WCC and the claims office. For the employer, it can mess up your loss run accuracy. The WCC will being call the employer and/or the claims office for the correct SS#. The claims office can submit the Insurance Services Office (ISO) inquiry with the fake SS#, but the likelihood of identifying previous insurance claims by the injured employee is greatly reduced when the SS# is not accurate.

 

 

Correct Date of Injury

When the date of injury is incorrect problems occur. In most workers’ compensation claims, the date of injury is also the date of the first medical treatment. Most claim management computer systems are programmed to kick out medical bills that occur before the date of injury. For example: an incorrect date of injury of 3-3-13 is entered on the First Report of Injury while the correct date of injury is 3-2-13. The medical bills from 3-2-13 will get denied because, to the computer system, they occurred before the date of injury. This results in phone calls from the medical provider(s) and the claims office trying to determine the correct date of injury.

 

 

Proper Wage Information

When the wage information on the First Report of Injury is incorrect, it will create problems, especially if the employee is represented by an attorney. Too often the employer’s representative will take the easy way out rather than contacting the payroll department for the correct wage information. When the employer’s representative completes the First Report of Injury reflecting the employee works 5 days a week, 8 hours per day, at the standard hourly rate for the work the employee normally does, without verifying with the payroll department, problems arise. For example, on a 40 hour week with a position that pays $10.00 per hour, $400.00 is entered as the weekly wage. But in reality, work has been slow; the employee has been absent a lot and has only averaged 32 hours per week. In this situation, the employee’s attorney often will request a hearing trying to compel the payment of disability benefits based on the higher payroll information entered on the First Report of Injury. This will force the claims adjuster to spent time and legal fees proving the correct earnings information.

 

 

Proper Type of Injury & Body Part Affected

The importance of properly entering on the First Report of Injury the type of injury and the body part affected cannot be overstated. One of the first things an attorney for the employee will do is check the First Report of Injury for the type of injury and the body part. If this information is missing, your represented employee’s injuries will expand dramatically. Neck and back injuries that you did not know the employee had on the date of injury will suddenly appear. The employee’s pre-existing medical problems will be severely aggravated. The additional medical treatment and extended time off work can be very costly when the type of injury and body part is not completed properly.

 

 

Double Check First Report of Injury Prior to Submission

Any incorrect or incomplete information on the First Report of Injury can result in problems. A lot of the problems created by wrong information can be corrected with a few phone calls or the resubmission of the First Report of Injury with the correct information. However, this is a waste of time for all the parties involved. Plus, when the First Report of Injury is inaccurate or incomplete, it can often be exploited by the employee’s attorney. To make the job easier for everyone related to the workers’ compensation claim, be sure your representative who completes the First Report of Injury checks it twice to be sure it is totally accurate.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


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

Filed Under: Claim Management Tagged With: , , , ,

The Role of the Risk Manager in Workers Compensation Cost Containment

January 3, 2013 by Leave a Comment

 

What is the Role of a Risk Manager?

 

A risk manager is responsible for a broad array of duties as the company sets up a workers’ compensation management program. To reduce costs, the risk manager should closely monitor the implementation of the program. Naturally, the responsibilities depend on the size of the department and amount of assistance that is provided.

 

Tips on What a Risk Manager Should Do:

 

  1. Determine the type of claims administrationarrangement. The risk manager needs to determine whether the type of claims administration you have is the right fit for your company and not take a one-size-fits all approach. The risk manager should perform an individualized assessment of your company’s strengths and needs to determine what arrangement works best for you.

 

  1. Ensure the adjuster-to-claim ratio is appropriatefor adjusters responding to your claims to get your workers back to productive employment faster. The risk manager needs to determine whether the adjuster has too many claims to process yours fast enough to keep your costs down.

 

  1. Consider whether your claims volume requires dedicated staff. The risk manager should assess whether the amount of workers’ compensation claims the company has requires one or more employees whose primary job function is to handle the workers’ compensation claims process.

 

  1. Follow claims administration’s best practicesto better comprehend the adjuster’s role. The risk manager should be up-to-date on the insurance industry’s standards and recommendations in claims handling to assess whether your procedures need to be updated.

 

  1. Make sure claims handling personnel are trained in injury managementconcepts so they can grasp the issues affecting your claims. The risk manager should make sure that personnel are familiar with the expected claims process, forms, medical terms, action plan, and potential issues. As your first-line defense, you want your claims handling personnel informed enough to spot issues that may arise.

 

  1. Visit an adjuster claims handling locationto see how your adjuster handles your files and view their claims operations first hand. There is no substitute for knowing exactly how your claim is being handled in the physical location where it is being processed.

 

  1. Attend associate seminars and meet with other industriesto observe how other organizations address workers’ compensation issues in today’s labor market.

 

  1. Maintain benchmarks for your professionshowing how potential savings generated by an effective injury management program far outweigh the initial costs of staffing.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


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

Filed Under: Risk Management Tagged With: , , , , , , , ,

The Search for Great Workers Comp Cost Containment Information

May 3, 2012 by Leave a Comment

One of the most difficult aspects of being a risk manager, workers compensation coordinator or workers comp manager is finding adequate resources on the subject of workers compensation. With each state having their own unique way of doing things, finding specific information can be daunting.   Of course you can Google any workers compensation subject and you will get a ton of information with some of it being useful or on point, but usually most of it does not apply. 

 
 
Good sources of information on workers compensation are available.  The U.S. Chamber of Commerce publishes annually an excellent guide called Analysis of Workers Compensation Laws, which is packed with tables showing how each state applies the law in different categories. A new print version is published only once yearly which may be a drawback for some, and it's published in the middle of the year, so the 2011 is the most current version until about July.

Also, each state will have their own website for workers compensation with some being more user friendly than others. Many state specific websites will cite the law by chapter and paragraph, but unless you are an experienced lawyer, that does not do much good. [WCx]
 

 
Other great source of information online are found at www.WorkersCompensation.com and their paid service Workers Compensation Research which provides updated state information as well as fill-in flash forms. Many carriers and self-insured employers use these forms and research tools.
 
 
There are technical schools, both on-line and classroom settings, that offer workers compensation training, but these courses are usually geared toward people who need state specific training to pass the state examination for a workers compensation adjuster’s license.  In a similar vein are the on-line webinars designed to teach you the basics in order to get the adjuster’s license or agent’s license.  These schools do not address the primary need of business, workers compensation cost control.
 
 
If you do an internet search for workers compensation cost control, you will find various articles on safety, or efforts to sell you a workers comp insurance policy with an insurance carrier. 
 
 
Recognizing the need for a multi-facet resource on workers’ compensation that employers can use to control their workers’ compensation cost, we created a detailed guidebook that is geared toward the needs of employers, Manage Your Workers Compensation Program, Reduce Costs 20-50%.
 
 
Our guidebook is focused on the information the employer needs to control workers compensation cost. It will show you how to plan and implement the workers compensation cost control strategy. There are in-depth chapters available.
 
  • Working with adjusters or TPA
  • Injury management best practices
  • Communicating with employees
  • Post-injury response
  • Reporting claims
  • Directing medical care
  • Return to work programs
  • Medical cost containment
  • Other cost containment services
  • Physical rehabilitation and physical therapy
  • Pharmacy benefit management
  • Fighting fraud
  • Training staff to control workers comp
  • Claim resolution and settlement
  • Safety and loss control
 
If you are just starting a workers compensation management program or realizing the need to overhaul the existing program, our guidebook will assist in assessing company needs, designing and developing the program, training and implementing the program, and monitoring and managing the workers comp program.
 
 
 Workers Compensation Management Program, Reduce Costs 20-50% places in one handy resource the information you need to control  workers compensation cost.  You could spend hundreds of hours researching on the internet and not find all the information we have compiled for you.  We believe our guidebook is the best available.  Please contact us to learn more about Manage Your Workers Compensation Program, Reduce Costs 20-50%.
 
 
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
 

Our WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

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Filed Under: Implementation and Rolling Out Your Program, Risk Management Tagged With: , , , ,

Five Ideas to Reduce Workers Compensation Exposure When Downsizing

March 5, 2012 by Leave a Comment

These are dreaded words heard ‘round the locker room or break room table.’  They may start out as nothing, maybe a little one-liner about “some layoffs coming down the road” or maybe another guy said he saw Keith talking to Bob about “Immediate downsizing.”

 

Whether these are true or untrue, as a risk manager or someone involved in the claims process, be ready for the onslaught of the consequences of layoffs or downsizing.  Not everyone will file a claim for workers comp, but bet the disgruntled employees will, along with a few unexpected employees to now report an injury of some sort in the past. (WCxKit)

 

 

How are these issues controlled and handled proactively? We discuss a few options below, and remember these may or may not apply in your jurisdiction.

 

Always consult counsel before implementing any of these ideas.

 

  1. Go back to documentation

Keith just received his letter that his job was terminated and his last day of work will be in 10 days.  Keith is nervous, because he has limited job skills, bills to pay. He lives in a small town and there are not a lot of jobs out there.  Plus he does not have the greatest relationship with his supervisor, and he feels this is a personal assault coming directly from that supervisor who just does not like him.

 

What does Keith do? Well he decides to say he injured himself a month or so ago but was afraid to report it, because he heard that layoffs were coming. And he did not want to be one of the guys picked to be laid off.

 

 

This is a very common scenario. And this is where attention to documentation comes in to play.  By now, everyone on the work floor should know that if any injury happens, whether they want treatment or not, the worker is to come to the risk manager’s office to complete some paperwork.  And those who decide not to do this face the consequences associated with not reporting it.

 

 

The first question to Keith after he tells you he hurt himself a month ago should be “Why did you not tell me?  You knew the procedure, right?  Did you tell anyone?  Did anyone witness your injury? Did you see your doctor?  Why are you telling me this now?”

 

 

These are the first handful of questions to ask.  Then call in his claim to the carrier/TPA immediately.  And let them deal with it.  If you still want to lay him off while his claim is under investigation, that is fine.  If you want to wait until a decision has been made, that is fine as well.   But documentation is key, and it always will be.  You have to constantly tell the workers the responsibility to come tell you when something does not feel right, and an injury may have occurred.  And if the employees do not do this then they face the consequences that can affect the claim’s compensability.  Make it a reminder phrase every week.

 

 

  1. Perform an exit interview

If a worker resigns from a position, or is laid off, chat with them a bit.  Chances are the worker will come to you anyway to ask why it was them anyway. So now is a good time to see if the employee  pulls out any angles to try and keep getting some income coming .  Flat out ask if the worker is hurt, or had a workers comp claim, or is experiencing pain for example.

 

Common knowledge will reveal that this is a way to increase your own claims, since if it is not mentioned then why stir the pot?  Actually, if employees are going to come forward and try being deceptive, better to confront it now versus 6 months from now.  A claim will result regardless. Granted, most people will say “No” and move on, but there is always that handful of people that will  try to claim an injury.   Call the claim in to the adjuster, and let them handle it.  That way you have performed your duty, and your responsibilities of reporting it are over and done.

 


  1. Have a medical exam performed by an occupational medicine doc or a local clinic doctor to be safe

In order to be ultra-aggressive, get a doc to do an exit-exam.  This will weed out all the fakers.  It is not going to be free, but weigh the costs.  If this is something to do to prove a point, then do it.  Take  time finding a doc that is also legit, and willing to do this.  In the grand scheme of things I guess it is not fantastic to be laying off people due to expenses, and then have to spend $4,000 to have a doc say these workers are fine and show no signs of disability. This is about protecting your company from the unknown future of compensation claims, some of which can become incredibly costly no matter how insignificant they seem.  So it is an option if that is preferred. Just make sure to have a credentialed doctor performing the exams in a private, professional setting (does this go without saying?), and that it is all HIPPA compliant.

 


  1. Ask the employees to sign a release waiving liability (if legal in your jurisdiction)

Probably the most common is just the legal paper stating that the worker is not claiming any disability at this time.  Depending on the jurisdiction, try inserting the word “future disability’ as well.  But my advice is to thoroughly check with the employment counsel, as well as the workers comp counsel on permission.  Or better yet have counsel draft the letter. Again it may cost something up front as far as expenses go, but it is all about protection down the road.

 


  1. With a witness present, ask if the worker was or is  hurt, or experiencing symptoms, and has been to the doctor for this. Ask is this is related to work or not.

This is similar to the doctor, but not as expensive.  Have another HR person present for the exit interview, and ask the person about any disability relating to work.  This will prevent the worker from coming back saying there were some problems swept under the rug and ignored. Check again with counsel on what can be and cannot be done, and then go from there. (WCxKit)

 

 

Summary:

With any type of employee reductions in the workforce, there are going to be some bitter feelings and resentment when reducing your number of workers.  This article is about protecting your company, and protecting the future of potential comp claims.  Any way to reduce exposure is always one worth researching, and implementing, sooner rather than later.

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.

 

 

Our WORKERS COMP BOOK:  www.WCManual.com

 

WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:   www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE:  Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

 

Filed Under: Fight Workers Comp Fraud & Abuse, Risk Management Tagged With: , , , ,

How to Use Video to Get the Employee Back to Work

February 6, 2012 by Leave a Comment
Sometimes, despite an employer's best efforts, some employees just do not want to come back to work (not having to work for a steady paycheck is a pretty good deal). The usual way employees block their return to work is by exaggerating the physical demands of their job. When asked by the orthopedic doctor how much lifting the job entails, the employee remembers the one time in his 20 years of employment where he picked up a 90-pound bag of concrete mix. What the doctor hears is the poor employee is lifting 90-pound bags all day long. The orthopedic in an effort to avoid a malpractice claim, tells the employee you cannot do that, and keeps the employee off work for another month.
 
 
A lot of savvy risk managers and workers compensation coordinators are furnishing the medical provider with a copy of the employees written job description as soon as they know who the medical provider is or is going to be. This often helps to get the employee back to work as soon as the employee is physically able to return to work. However even with a written job description, there are times the doctor does not have a clear understanding of the employee’s job.(WCxKit)
 
 
With YouTube and all the other video display sites on the internet, the use of video to show and describe things is quite common. Video job descriptions are now easy to create, simple to watch and they make it much easier to understand processes when the medical provider is not previously familiar with them. There are also videos and photos on Facebook that are now commonly used to dispute claims on inability to work.
 
 
Before you start making a video of the employee’s job, stop and plans what you want to show. Read through the written job description. Does it cover everything the employee does? Ask another conscientious employee who does the same job how the written job description can be improved (no need to mention the other employee’s work comp claim). Be sure to make note of everything the currently working employee states needs to be added to, or taken out of, the existing job description.
 
 
Obtain a copy of the injured employee’s medical restrictions. Identify the limitations the medical provider has placed that are preventing the employee from returning to work (this will be important when making the video record of the job description).
 
 
Ask the working employee to allow you to video record the work routine, the daily task and the most difficult parts of the job. Be sure to capture on the video the way the working employee has to move, bend, stretch, twist, walk, sit, stand, etc. Show all repetitive motions. Show all lifting whether it is a 40-pound box of materials, or a feather-light single piece of material.
 
 
Be sure to have the sound turned on during the video of the job and ask questions. Some of the questions you will want answered in your video include:
 
1. How much does that item weigh?
2. How often do you have to pick up the item?
3. Is it easier to do your job sitting down or standing up?
4. How far do you have to reach?
5. How many times a day to you repeat that motion?
6. What can be done to make the physical demands of the job easier?
7. Show me the most difficult part of your job.
8. Without mentioning the injured employee, ask about each limitation that has been placed on the injured employee, for example:
a. “If for safety reasons we said not to lift more than 20 pounds, could you still do your job?”
b. “If you were unable to stand for more than four hours at a time, would you be able to do the job sitting down?”
c. “Would it make the job easier if you alternated between standing and sitting?”
d. “Would you be able to do your job if we limited the repetitive motion to XX repetitions per hour?”
 
 
Keep in mind there is the possibility that the conscientious employee will state “you cannot do this job if you cannot lift 40 pounds” or something similar that will validate the fact the injured employee is not malingering and really cannot return to work, yet.
 
 
If necessary, edit your video job description to keep the length down to about five minutes. That is about as much time as you can expect the doctor to take away from his/her many other duties to watch the injured employee’s video job description.
 
 
When you are satisfied the video record will answer all the potential concerns of the medical provider and properly portray the injured employee’s job, ask the nurse case manager to view the video job description. See if she has any concerns about the injured employee’s capabilities to return to work. If she does, determine how the job might be modified for the injured employee to return to work.(WCxKit)
 
 
The nurse case manager is a good way to get the video record in front of the medical provider. The nurse case manager can explain your desire to get the employee back to work and also explain how any necessary job modification will be accomplished to meet the injured employee’s restrictions. If necessary, add to the video any job description changes needed to accompany the employee’s restrictions, showing the way the modified job will be done. When the medical provider sees the employee can do the regular job, or a modified duty job, the formerly injured employee will soon be back to work.
 
 
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
 

NEW 2012 WORKERS COMP BOOK:  www.WCManual.com 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Filed Under: Communication with Employees, Fight Workers Comp Fraud & Abuse, Return to Work and Transitional Duty Tagged With: , , , , ,

TPA and Insurance Carrier Roles For Dummies

October 4, 2010 by Leave a Comment

If you think all the claims people are located in the claims office, you would be in the large majority of the risk and insurance world, and you would be wrong. There are various types of claims people in support and management roles at the insurers and the third party administrators (TPA) who have a major impact on the success of your workers’ compensation program. Here is a brief synopsis of the other claims people you may never hear about.

 

Account Administrator/Risk Technical Adviser

This position was previously known as the “home office examiner,” but insurance companies and TPAs have renamed the claims position in several different ways. In some companies it will still be referred to as the “home office examiner,” but other names like “account administrator” and “risk technical adviser” are being used to describe the position.

 

The home office examiner/account administrator/risk technical adviser is a person with a tremendous amount of claims knowledge, claims experience and “know how” who oversees the catastrophic injury claims — the more difficult and expensive claims. The home office examiner’s role is to be a “second set of eyes” on the file. The home office examiner will review the catastrophic injury claims to be sure the medical management, disability management and resolution of the file is handled in the best interest of the insured and the insurance company. (WCxKitz)

 

The home office examiner will provide direction and supervision whenever the claims office asks for guidance. The home office examiner will also intervene if the course of the claim is not what it should be. At TPA’s this role will also encompass verifying the claim offices are complying with all the requirements of the client.

 

Account Manager

The account manager for the insurance company, or the TPA, is a hybrid role between a claims person and a salesperson. The account manager acts as a liaison between the employer, the insurer and the TPA, when a TPA is handling the claims.

 

Often the account manager is a direct contact for the employer’s risk manager or claims coordinator with the intent of resolving all insurance program related problems and answering all questions about the insurance program. The account manager is the go-to person to resolve any issues that arise whether it is compliance by the claims office with the service standards, the deletion or adding of new locations to the insurance program, the resolution of questions about the program or the corrections of any errors or mistakes in the data management.

 

Nurse Case Manager

The role of the nurse case manager is to provide medical expertise beyond the knowledge the adjuster will acquire from reviewing medical reports and medical histories. The nurse case manager is a license practical nurse or a registered nurse who has the nursing degree plus years of experience in the medical field. (WCxKitz)

 

When the nature of the injury is severe and the adjuster wants medical management of the claim to be provided, the nurse case manager is assigned to the claim file. The nurse case manager will coordinate and facilitate the health care services provided to the injured employee to assist the employee in achieving the best recovery possible.

 

The nurse case manager will provide to the adjuster a patient assessment and a treatment plan that has been coordinated with the medical provider. The implementation of the treatment plan and the execution of the treatment plan are part of the nurse case manager‘s responsibilities.

 

Not only is the nurse case manager an adviser to the adjuster but also a trained medical expert who can answer the medical questions the injured employee may have between medical provider visits.

 

Adjuster-in-charge

The adjuster-in-charge, also known as a “resident adjuster,” is often used when a large employer wants an on-site adjuster to handle their workers’ comp claims. This facilitates the immediate reporting and the immediate investigation and handling of each new injury claim. The adjuster-in-charge is an employee of the insurer or TPA, but is domiciled at the employer’s location or in a one-person office near the employer.

 

The adjuster-in-charge will be an experienced adjuster who is capable of working independently from an on-site supervisor. The workload of an adjuster-in-charge will normally include a mix bag of simple workers’ comp claims to the most severe claims. The position often entails the adjuster having to do everything from taking in the new assignments to the closing of the claim files. (WCxKitz)

 

Regional Manager

When an insurer or TPA has a large number of claims offices, the supervision of those claims office is often broken down into regions of the country. The regional manager is responsible for the services provided by the claims offices in the territory or region.   The regional manager provides the direction to the claims offices and provides the home office management with a greater degree of control.

 

Vice President of Claim

At the top of the claims hierarchy is the vice president of claims. The responsibilities of the vice president of claims includes the planning, organizing, directing and controlling of all the activities of the claims offices and claims regions. The vice president of claims is also responsible for the performance of the claims offices, the profitability of the claims offices and the claim services provided. (WCxKitz)

 

Summary

The various support roles outside of the workers’ comp claims office are often the keys to the success of the claims program. Whether it is the claims examiner keeping the high dollar files on track, the account manager resolving all the issues that come up, the nurse case manager providing the necessary medical expertise or the senior management overseeing the claims program, they all can have a positive influence on making your workers’ comp insurance program successful.

 

 

Author Rebecca Shafer, J.D, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact:  RShafer@ReduceYourWorkersComp.com .

WC Calculator:  http://www.LowerWC.com/calculator.php
TD Calculator:  http://www.LowerWC.com/transitional-duty-cost-calculator.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.


©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

 

Filed Under: Risk Management, TPA and Claims Administration, WC 101 Tagged With: , , ,

Top Ten Best Practices for Your Risk Manager for Workers Comp

July 30, 2009 by Leave a Comment

The risk manager  is responsible for a broad array of risk-related duties, including overseeing the injury coordinator as the workers’ compensation management program is implemented. As a risk manager your key responsibility is oversight of the workers’ compensation injury management program. Cost reduction requires close monitoring.

The risk manager follows these guidelines:

  1. Determine what  type of claims administration arrangement your company has.
  2. Ensure the  adjuster-to-claim ratio is appropriate for adjusters responding to your claims to get your workers back to productive employment faster.
  3. Consider  whether claims volume requires dedicated staff to provide oversight and input about how you want your claims handled and to implement your injury management program.
  4. Familiarize  yourself with claims administration best practices to better comprehend the role of the adjuster.
  5. The claim  handling process should go smoothly. If it doesn’t you want to be sure you have realistic expectations about how your claims are handles. Don’t assume you are the one who is wrong!
  6. Make sure  claims handling personnel are trained in injury management concepts so they grasp the issues affecting your claims.
  7. Visit  an adjuster claims handing location to see how your adjuster handles your files, and view their claims operations first hand.
  8. An on-site  visit is an opportunity to develop a positive relationship with adjuster and clarify expectations, procedural issues, special handling instructions, etc.
  9. Attend association seminars and meet with other industries to observe how other organizations address workers’ compensation issues in today’s labor market. (workersxzcompxzkit).
  10. Maintain benchmarks  for your profession showing how potential savings generated by an effective Injury Management Program far outweigh the initial costs of staffing.

Author: Robert Elliott, J.D.

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Do not use this information without independent verification.
All state laws vary.

©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Filed Under: Implementation and Rolling Out Your Program, Management Commitment, Risk Management Tagged With:

The Role of the Risk Manager in Workers Compensation Cost Containment

April 12, 2009 by Leave a Comment

A risk manager is responsible for a broad array of duties as the company sets up a workers’ compensation  management program. To reduce costs, the risk manager should see his role as closely monitoring the implementation of the program. Naturally, the responsibilities depend on the size of the department and amount of assistance that is provided.
Tips on what  a risk manager should do:
1. Determine what type of claims administration arrangement the company has.
2. Ensure the adjuster-to-claim ratio is appropriate for adjusters responding to your claims to get your workers back to productive employment faster.
3. Consider whether claims volume requires dedicated staff.
4. Familiarize yourself with claims administration’s best practices to better comprehend the adjuster’s role.
5. Make sure claims handling personnel are trained in injury management concepts so they can grasp the issues affecting your claims
6. Visit an adjuster claims handling location to see how your adjuster (workersxzcompxzkit)
handles your files and view their claims operations first hand.
7. Attend associate seminars and meet with other industries to observe how other organizations address workers’ compensation issues in today’s labor market.
8.Maintain benchmarks  for your profession showing how potential savings generated by an effective injury management program far outweigh the initial costs of staffing.

Author:  Robert Elliott, J.D.
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Filed Under: Risk Management, Workers Comp Kit Tagged With: ,

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