WorkComp Advisory
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Lower the costs of claims with effective claims management
Follow-up checklist for job-related incidents

Recently, an employer expressed concern that an insurance company did not have an equivalent interest in managing a malingering claim. It felt that the quarterly claim reviews, a standard practice among insurance companies, was not producing results fast enough.

Insurance companies process thousands of claims per year and most work on an episodic process – waiting for a test to be scheduled or to a receive a doctor’s report, etc. For some claims, they seem to function more as stenographers – recording and sharing information – rather than intervening to improve outcomes.

It is well established that early intervention in problem claims is critical to controlling costs. If things are not on track in the first week or two, it is going to be difficult to get back on track. The longer a claim is open, the less likely it is to produce good results.

Employers cannot leave claims management to insurance companies; they need to be proactive and take a leadership role in resolving problem claims early in the process. Along with the employee, the employer has the vested interest and resources to improve the outcome.

While each claim is unique, each should be viewed as part of a long-term claims program. Most employers have witnessed seemingly minor injuries spiral out or control. Consider the analogy of an automobile assembly line. If the quality control were only at the end of the process, the costs of rectifying problems would be prohibitive. In claims management, quality control needs to be built into the total process, beginning at the time of the injury. If an employer waits until the claim becomes a problem, it is unlikely it can stop the escalating costs.

The employer should have a plan of action that focuses on getting the injured employee the right treatment, from the right doctor, at the right time and safely back to work as soon as possible. On-going communications need to take place among employer, physician and the injured employee. It is not uncommon for physicians to have the perception that insurance companies are looking for discounts and low costs. As a result, physicians tend to trust employers more, recognizing that they understand the job requirements, want the proper treatment and will honor restrictions.

Moreover the employer’s interaction with the injured employee is key to the process. If communication with the injured employee is left to the insurance company, the employee feels unappreciated and unneeded, thus, less compelled to return to work. Many employers have begun making injured employees more active participants in the treatment of their work-related injuries by holding them accountable for providing information on the availability of a Return-to-Work program, immediately reporting the results of each physician visit and providing regular updates on their condition and ability to return to work.

A key element of the action plan is establishing target dates. If these dates are not met, employers need to immediately probe and ask why, taking steps to get the process back on track. There should be defined protocols for monitoring progress, a tracking system for medical appointments and intervention and clearly designated staff responsibilities.

Employers can decide the extent to which they want to be involved in the claims management process. However, only those who take ownership of the process and strive for results will achieve long-term cost reductions in Workers’ Compensation. While actions may vary depending upon the claim and the company’s policies, click here for a follow-up checklist that can be helpful in developing an action plan.