Two keys to reducing
costs: prompt reporting and nursing triage
Prompt claim reporting can be a challenge for employers that have experienced
reductions in workforces; however, its importance should not be overlooked.
Statistics documenting the costs of delayed reporting are plentiful. The
Hartford Research Study (2004) found that claims filed a month or more after
an injury cost an average of 48% more to settle than those reported in the
first week. Even a week’s delay can increase claims costs by 10%.
According to a National Council on Compensation Insurance (NCCI) study,
late reporting also means more attorney involvement. 22% of claims reported
within ten days are litigated compared with 47% of those reported more than
31 days after the injury occurred. Furthermore, delays in reporting a claim
means delays in starting appropriate medical treatment – adding to
the cost of medical care and wage replacement.
To effectively control claims, a 24-hour injury response process must
be in place.
Some employers have taken this a step further and instituted telephonic
nursing management to promote prompt reporting and offer immediate injury
medical intervention. Called nursing triage, this system has long been used
by group health plans to provide members with medical advice and to triage
patients to the most appropriate level of care. Now many employers are leveraging
the same strategy to reduce their Workers’ Comp costs.
An employee who is injured at work calls a nurse-staffed case management
helpline to report an injury any time of day. Nurses are trained to perform
thorough questioning to gather comprehensive injury information, which assists
in claims management. The triage nurse handles all the required paperwork
and completes the first report of injury, disseminating it quickly to all
the appropriate stakeholders, including the employer, supervisor, physician
and claims administrator. This allows each stakeholder to respond quickly
and optimally impact the claim’s outcome.
Beyond timely reporting with nursing triage, every injury receives the care
and treatment appropriate to its level of medical severity. This process
removes the supervisor from the medical component of the claim. Lacking
medical skills, supervisors often err on the side of caution, sending employees—even
those with minor injuries—to the emergency room, costing several hundreds
of dollars.
Using treatment protocols and sophisticated algorithms, the triage nurse
systematically identifies the right course of treatment. With minor injuries,
the nurse may provide simple first aid or self care guidelines over the
phone, or send the patient to an occupational clinic in the employer’s
preferred provider network.
A Public Entity Risk Institute (PERI) report, The Day of Injury Study
2005, that studied the nurse triage program instituted by the Schools
Insurance Authority (SIA) in California concludes that employees were highly
satisfied with the nurse triage process and that 94% of all claims requiring
only first aid advice remained in a no-claim status 90 days post injury.
Litigation rates dropped 67% and remained about 20% below the California
state average for Workers’ Comp claims.
There are other cost-saving benefits of a nurse triage system. Increased
utilization of preferred occupational medicine providers and coordination
with return to work programs help reduce lost days, indemnity costs, disability
expenses and temporary labor expenditures.
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