Workers Comp Medical Only Claims
Recently, I posted on the pitfalls of Workers Comp medical only claims. That article is here. The worst medical only claims nightmare results from claims festering – or an unknown claim that sits with undiscovered liability.
There is a very small window of time where a claim can be investigated – regardless of whether it is a medical only or a lost time Workers Comp claim. The three point contact (Employer, Employee, and Medical Provider) must be made within 24 hours. This allows for a timely and proper accept/deny decision.
If an employee has not drawn Workers Comp benefits, these claims are usually lumped into the Medical Only category. There are a few exceptions.
Medical benefits are paid timely, but the claim is becoming more serious without any monitoring. The medical bill expense may not necessarily signal any problems if the injured employee keeps working and only has medical office visit and prescription expenses.
Who monitors these claims? The answer is usually no one. Yes, there is a medical only adjuster than may alert their supervisors on a few of this type of claim. They are usually too overloaded with volume to read every medical report.
The ability to spot these claims is an art unto itself. How does an employer monitor these claims? I will cover that next time.
Article provided by James J Moore, AIC, MBA, ChFC, ARM. All articles are original content. Check out the full website at www.cutcompcosts.com.