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.