Asheville, NC (CompNewsNetwork) - The costs of a claim and the impact on the company's Experience Mod are more severe the longer a claim remains open. Here are 13 tips to help you shorten the duration of a claim:
1. Require all employees to report accidents immediately, no matter how minor.
2. Thoroughly investigate accidents immediately after they are reported. Separate witnesses from the injured employee to get the whole story and signed statements.
3. Stay in contact with the employee. Immediately assign someone, preferably the supervisor, to stay in touch with the employee on a regular basis to keep the injured employee motivated to return to work. Positive, encouraging messages of the employee's value to the company are often the best medicine.
4. Assist the employee in understanding and filing the necessary claim forms. Answer the employee's inquiries quickly and efficiently, preferably designating one person as the primary contact.
5. Be cognizant of the employee's emotions. If the injury is serious, employees can become depressed or angry and may need assistance.
6. Understand your state's waiting period for indemnity payments. Waiting periods for employees who are eligible for wage replacement benefits pursuant to the Workers' Compensation Law vary by state, generally ranging from 3 to 7 days. When the injured employee does not receive pay, the waiting period can create a sense of urgency to return to full or modified duty. In addition, the moment injured employees become eligible for indemnity, they are being paid not to work. When they understand that the payments are tax free and not that much different from their take home pay, there can be a fundamental shift in motivation to return to work, particularly if they are ambivalent about their job or if the future of the job is uncertain.
7. Identify and establish relationships with doctors who have an expertise in occupational medicine and understand the value of returning injured employees to work.
8. Have a Return-to-Work program in place. Be sure the injured employee, supervisor and fellow employees understand the work restrictions. A common cause of reinjury is that the supervisor does not educate others about the work restrictions and, unknowingly, peers place pressure on the injured employee to perform tasks beyond the restrictions.
9. Eliminate disincentives to return to work. While federal and state laws govern what employers can do in this area, reducing the injured employee's salary for a short-term modified duty position can send a powerful message to the employee that returning to work is not a good idea.
10. Use medical disability duration guidelines as a resource not a hammer. Every employee is different and recovery from the same injury will vary from employee to employee based on age, overall health, etc. The disability guidelines provide a common framework for non-adversarial communication between all interested parties–employers, employees, medical providers and insurance companies as to the anticipated treatment plan and return to work timetable.
11. Monitor claims progress. Review loss reports from the insurance company and identify those claims that are not progressing as expected. Discuss the claims with the medical provider and your insurance adviser to determine how to get the claim on track.
12. Know your claims. If you have a high number of claims with an indemnity payment of less than $1000, there is a clearly missed opportunity in returning workers to modified duty and controlling increases in Experience Mod. Moreover, by examining your claims, patterns may emerge that identify areas in need of attention.
13. Close claims promptly. Open claim reserves affect the Experience Mod in the same way as actual claims paid. In some cases, claims that are closed may be on the books as open or the reserves set for the claim may be excessive based on your knowledge of the claim.
This material is provided as general information and is not a substitute for legal or other professional advice.
About Teresa A. Long
Teresa A. Long is Director of Agency Services for the Institute of WorkComp Professionals in Asheville, NC, the largest network of Workers' Compensation professionals in the nation. Teresa was claims manager for 14 years for Walt Disney World and later was Vice President of Risk Management for Sarasota, FL-based Unisource Administrators, Inc.
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