Employers Stepping Up: Controlling the Work Comp Claim Process

23 Aug, 2021 Rebecca Shafer

                               

It is time for employers to take control of the workers’ compensation process to reduce program costs. This includes taking responsibility for contacting the injured employee, obtaining the required information, and coordinating with the workers’ compensation claim team. When this occurs, employees will return to work promptly following an injury, and there will be actual savings in the process.

Taking Responsibility for the Process

Employers need to take responsibility for the process following a work injury. This allows the claim management team to spend their time managing the claim – the big picture.  Issues that employers need to be responsible for include:

  • Dedicated staff manage workers’ compensation claims and serve as an intermediary with the employee and claim management team. These staff members need to be proactive in getting the necessary information in a timely manner.  Examples can include medical authorizations, medical records, notes, and wage records to ensure the average weekly wage is correctly calculated.
  • Dedicated staff that assists in return to work issues. Return to work is an integral part of every claim that often is ignored or not discussed until sometime after the work injury.  Getting the employee back to work following a work injury is considered after the employee is stabilized following the incident.
  • Dedicated staff that has procedures in place that ensure a timely reporting of the work injury. Every work injury needs to be reported within 24 hours.  Countless studies demonstrate better decisions are made when an injury is reported immediately following the incident.  This must include having platforms accessible to all employees to report an injury.

Interested stakeholders looking to reduce workers’ compensation costs must take responsibility for the process. This assists the claim management team in directing the claim and managing the process.

Vital Information that Needs to be Obtained

Employer representatives and staff play an important role in locating information related to the claim process.

  • Basic Claim Information: Employers have access to basic claim information.  This can include the mailing address, telephone number, and email address of the employee.
  • Injury Information: Employers can provide documentary evidence to the claim team such as photography, security video film, and other information about an incident when it occurs on company premises.  Other examples include information on machinery and other equipment that was being used at the time the injury took place
  • Medical Information: Employers can play a role in locating the names of health care facilities where the employee is receiving or has received medical care.  They can contact office staff to obtain additional information, including more specific information on restrictions on the employee’s activity and proper authorizations.
  • Workability: Return to work is vital.  Employers have access to information that can assist the employee in getting back to work and reduce program costs

 Coordination with the Claim Management Team

Employers can better manage the workers’ compensation process when they have frequent contact with the claiming team handling claims. Essential functions should include:

  • Contact with the claim handler on information crucial to the claim. This will assist the claim handler in their efforts to manage the claim and gather all relevant information.
  • Provide information regarding the compensability of a claim. This is important for unwitnessed injuries or gathering information regarding personal activities the employee may have been involved in before and after the injury.
  • Continue to monitor return to work efforts and discuss opportunities to get the employee back to work. This can include “work on loan” opportunities.

Frequent communication between the employer and insurance carrier/TPA helps drive ideas that get injured employees back to work and reduces money spent on medical costs.  When done correctly, it can promote an efficient workers’ compensation program that ensures the employee is paid all benefits they are entitled to receive and promote fairness in the system.

Conclusions

Employers have an important role to play in the workers’ compensation process.  This includes serving as a resource to the claim management team by providing information and assisting in managing the process.  Now is the time for interested employer stakeholders to review how they interact with their insurance carrier or third-party administrator and reduce costs by better managing the process.

 


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    • Rebecca Shafer

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