Three strategies to prevent a claim from derailing

As economies reopen and employers struggle to find qualified workers, risk managers worry that less skilled, untrained new hires as well as the deconditioning some workers experienced during the COVID-induced recession may lead to a spike in incident frequency or severity. The statistics on injuries incurred by new hires are alarming. In 2019, the Bureau of Labor Statistics reported that 34% of workers with nonfatal injuries were on the job for less than a year. Also, one of every eight workplace injuries occurs to employees on their first day according to OSHA.

The workers' comp system is complex, difficult to navigate, and filled with possible pitfalls. 80 - 90 percent of workers who are injured on the job are dealing with the system for the first time. They can easily be overcome with worry about their job, their income, their health, their family, and how coworkers will perceive them. The knowledge they have about the process and the immediate response by the employer will determine the course of the claim. Here are three things employers can do to prevent the claim from derailing:

1. Position Workers' Compensation as a valuable benefit during onboarding and reboarding

   An injured worker's unfamiliarity with workers' comp is a precursor to delayed recovery and increased cost. While nobody likes to talk about getting hurt on the job, it's important to present workers' comp as an important benefit and present it in a positive way. "It's the company's responsibility to take care of you if you get hurt. The only acceptable outcome is to get you back to work as quickly as possible." Then describe the process and protocols, providing literature, online resources, or apps that the employee can access when needed. Committing to staying involved throughout the recovery process, letting them know who to talk to if they have a problem, and explaining the role of the adjuster, employer, and physician can ease their anxiety and build trust.

   The injured worker also needs to understand their responsibility, especially as it relates to injury reporting, medical care, and recovery at work. The third annual Workers' Compensation Insights Survey conducted by Healthesystems in collaboration with Risk & Insurance magazine found that 50 percent of workers delayed reporting injuries due to system complexity, waiting to receive paperwork, lack of clarity about process, and self- imposed delays, such as pain not severe or self-care. Delayed reporting can increase claim costs by 51 percent.Claims from workers who feel valued, trust the employer, and follow the protocols will have the best outcomes.

2. Develop a relationship with top-performing providers

   Treating physicians have a profound impact on the ultimate cost of a claim, deciding which medical treatments to use, whether an injured worker should lose time from work, and when they are ready to recover to work. Medical costs now make up about 60 percent of the the cost of claim, up from 40 percent in the early 80's, and the average medical cost per claim has more than tripled in the past two decades.

   Coventry, a leading provider of care-management and cost-containment solutions for Workers' Compensation has released a new whitepaper entitled "Proven track records create a winning formula for injured workers' recoveries."

   To understand the physicians best equipped to help injured workers, "it's wise to have a balanced measurement design that encompasses multiple claim aspect outcomes such as medical utilization, clinical benchmarks, indemnity spend, return to work, financial performance, and quality measures." A review of 3.1 million closed claims over five years showed this can lead to a 25-35 percent reduction in claim duration, 55-65 percent fewer opioid prescriptions, and 40-50 percent lower average medical and claim costs.

3. Avoid low-cost indemnity claims

   Waiting periods for employees who are eligible for wage replacement benefits vary by state, generally ranging from 3 to 7 days. The moment injured employees become eligible for indemnity, they are being paid not to work, your Experience Mod is affected, and rates start to climb. Importantly, in some states medical-only claims are discounted by 70 percent. Employers have control - if lost time isn't needed, bring the employee back to work and avoid the indemnity payments. We've written often about the value of a recovery-at-work program, which reduces claim duration, engages the injured employee, lowers the possibility of litigation, speeds recovery, and lowers premium costs.

   With rare exceptions, employers should be able to modify an employee's duties to accommodate work restrictions. It doesn't have to be the same job eight hours a day/ five days a week and can be modified as restrictions are lifted. Employers who establish a recovery-at-work program with a job bank of possibilities before there is a need can facilitate the return to work with relative ease.