5 Crucial Steps for Managing a Workers' Compensation Claim

Managing a claim following a workplace injury can seem daunting. Is all the necessary information being reported? How much communication with the employee is appropriate? Is the injured worker getting the care they need? These are all questions that employers may have following an injury to one of their employees. The truth is, no matter how focused you are on safety and accident prevention, claims are inevitable. In the event an employee is injured, steps can be taken to minimize both recovery time for the employee and overall claim cost. Aside from reporting the incident to your claims partner, being prepared and knowing what steps to take can make all the difference. Here are five tips employers can use for effective claims management:

  1. Injury Reporting - Employers should always have an injury reporting procedure. When an incident occurs, the initial process of gathering information is crucial. The employee should complete a written injury report and the employer should be sure to ask any additional questions that may be necessary to assist their claims partner in the investigation. No matter what policies an employer may have in writing, a culture of prompt reporting should be instilled so that all employees understand the importance of reporting an injury. The reporting process should be discussed upon hire, listed in the employee handbook and continuously communicated to the workforce.
  2. Medical Care – It is important to have a plan of action for medical care following a workplace injury. Depending on the severity, a visit to the Emergency room may be necessary but if it is something minor, an employee may be able to wait for an appointment with an occupational health clinic. In either instance, it is essential to be prepared. In many states, the employee is able to choose his or her own care provider. However, in states where care is directed by the employer, it is extremely valuable to create relationships with local occupational health clinics that can provide the care an employee needs while having an understanding of the employer’s business. Many doctors will agree to tour an employer’s facility to better understand how injuries occur and determine what forms of treatment may be most beneficial. If a provider panel is required, it is important to work with your claims partner to understand the state specific requirements and select the right doctors to add to the panel.
  3. Submitting the Claim – Claims should be reported to your claims partner as early as possible, preferably the same day as the occurrence. This allows an adjuster to begin working the claim immediately so they can properly investigate compensability and also help get the injured employee the appropriate care that they may need. Lag time between when an injury occurs and when a claim is reported to an adjuster can not only cause delays in treatment but also drive up claim costs. Be familiar with the reporting process and submit to your claims partner as soon as possible.
  4. Communication – In the event of a workers’ compensation claim, it is essential to ensure the employee understands the process and what to expect going forward. Your claims partner should be consistently communicating with the injured employee but it is always helpful if the employer continues regular communication as well. In many cases, employees retain attorney representation because they may not understand the claims process. Clear communication with injured employees is essential initially and throughout the entire claim process. Employees should understand what to expect with medical treatment, payments and how their payroll and benefits will be impacted. Focusing on developing an effective communication strategy with both the employee and your claims partner lays the groundwork to successful claims handling.
  5. Return to Work – It has been proven that employees who return to light duty, or modified work, recover from their injuries faster, are less likely to retain an attorney and have a smaller chance of permanent effects from their injury. An employee returning to work can also decrease the cost of the claim drastically as indemnity benefits can either be reduced or even suspended altogether. It is crucial to work together with your claims partner to be sure a return to work procedure is in place. Whether an employer has an internal return to work program or utilizes a non-profit organization, getting an employee back to some work capacity will greatly reduce the cost of the claim and positively impact an employer’s Experience Modification Rate (EMR).

CBCS is a leader in every facet of workers’ compensation claims management. Our goal is to help achieve favorable outcomes for your employees in order to avoid any interruption to your business and reduce your overall workers’ compensation costs.

We provide a full range of medical cost control services, deep provider discounts, innovative claims technology and a proven program to help reduce drug costs. Our experience in handling complex claims, coupled with these extensive claims services continues to drive measurable results for our clients. If you’re interested in learning more and achieving better claims outcomes, contact a CBCS representative today.

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