Greetings! So, is there a best practice approach to claims control that truly works, and benefits everyone involved - the employer interested in reducing expenses, the manager responsible for production, and the injured or ill worker as her or she traverses the path to a full recovery? Yes, there is! I hope this forum will be of benefit to those of you with the
arduous task of managing workers' compensation claims. I learned the hard
way after being promoted to Director of Corporate Health
Services for a large health care system. I've decided to
share my 'common sense' program design with you. You see, managing workers' compensation claims doesn't have to be difficult.
Each week I'll add an element that is easy to incorporate into your existing program that has been proven to work! If you are anything like me, the confusing volumes of information available on loss prevention cannot be compared to practical experience, by someone who is practical and not paralyzed by detail. I hope you will trust me. I have both an RN and an MBA and experience with revenue generating and non-revenue/cost center responsibilities in workers' compensation program management.
So, what is the first rule, never to be broken? Your injured or ill worker must report the injury or illness prior to the end of his of her shift. Simple right? Make sure this is included in your policy and procedure manual immediately if not sooner. It is the most significant element of a loss control program. But consistency is key. You must never relax this for anyone in the organization, including upper management. Let them know that they will be pleasantly surprised to see that suspected fraudulent claims if you have them, will suddenly drop off. It's very easy to enter a false claim from days or weeks ago, but difficult to do the same day of the fabrication.
However, most claims are legitimate. But many injured or ill workers worsen their condition after leaving work if they don't know what their restrictions are, like picking up children or mowing the lawn. Without medical evaluation they can worsen an injury, which your employer will pay for in lost time and medical expenses. Additionally, you as the manager need an immediate awareness of the issue to implement corrective action and prevent additional injuries, the ability to discuss the situation with witnesses if any, and the opportunity to provide the injured or ill worker with that immediate medical attention.
This one policy requirement reduces the cost of workers' compensation by positively influencing the outcome of the claim. Good medical care is immediate and includes discharge instructions to be followed both at work and at home. Be sure your workers are aware of this - work restrictions apply to both. All best practice loss control programs contain this critical policy requirement. You can also include that if employees do not comply with policy then your insurer or Third Party Administrator may deny the claim. They may or may not, but putting this information out there is another way to encourage compliance.
I have a new blog: Please check it out here: The Biological Human - Wellness Tips for Body, Mind & Soul
Each week I'll add an element that is easy to incorporate into your existing program that has been proven to work! If you are anything like me, the confusing volumes of information available on loss prevention cannot be compared to practical experience, by someone who is practical and not paralyzed by detail. I hope you will trust me. I have both an RN and an MBA and experience with revenue generating and non-revenue/cost center responsibilities in workers' compensation program management.
So, what is the first rule, never to be broken? Your injured or ill worker must report the injury or illness prior to the end of his of her shift. Simple right? Make sure this is included in your policy and procedure manual immediately if not sooner. It is the most significant element of a loss control program. But consistency is key. You must never relax this for anyone in the organization, including upper management. Let them know that they will be pleasantly surprised to see that suspected fraudulent claims if you have them, will suddenly drop off. It's very easy to enter a false claim from days or weeks ago, but difficult to do the same day of the fabrication.
However, most claims are legitimate. But many injured or ill workers worsen their condition after leaving work if they don't know what their restrictions are, like picking up children or mowing the lawn. Without medical evaluation they can worsen an injury, which your employer will pay for in lost time and medical expenses. Additionally, you as the manager need an immediate awareness of the issue to implement corrective action and prevent additional injuries, the ability to discuss the situation with witnesses if any, and the opportunity to provide the injured or ill worker with that immediate medical attention.
This one policy requirement reduces the cost of workers' compensation by positively influencing the outcome of the claim. Good medical care is immediate and includes discharge instructions to be followed both at work and at home. Be sure your workers are aware of this - work restrictions apply to both. All best practice loss control programs contain this critical policy requirement. You can also include that if employees do not comply with policy then your insurer or Third Party Administrator may deny the claim. They may or may not, but putting this information out there is another way to encourage compliance.
I have a new blog: Please check it out here: The Biological Human - Wellness Tips for Body, Mind & Soul
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