Twilight Zone Phone Calls Reduced By Fast First Reports Of Injury
Twilight Zone phone calls not only irritate a claims staff. They can also cost plenty at time of policy renewal.
I coined the term Twilight Zone phone calls many years ago. I have written a few articles on the subject. Yesterday, in a presentation, I dusted off the old term as it is so applicable to a communications breakdown between all parties involved in a Workers Comp claim.
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The term refers to a phone call that usually comes in from a medical provider to a Workers Comp adjuster. You may fill in the blanks at will.
Hello, this is***Medical Provider****. We have ***injured claimant*** here for ***some type of treatment***. We were just calling to authorize the **medical treatment***.
Now, if the claims department received nothing yet from the employer, the call quickly becomes a Twilight Zone phone call which ends up being very costly.
Costly – Why? Let us go over the nine main reasons.
- The adjuster cannot authorize treatment. He/She needs the First Report of Injury as that document gives them the legal right to do something on the claim. Without it, there is no claim – yet.
- The medical provider becomes concerned as the injured employee is at their offices.
- The injured employee hears all this negative information and thinks maybe I should get some legal advice.
- The adjuster then has to stop everything and call the employer to nail down the First Report of Injury filing status
- The employer violated #1 of my Six Keys To Workers Comp Savings – Timely First Reports
- All the parties in the claim have been introduced in a trial by fire manner.
- The initial TTD payment checks run late getting to the injured employee<<<Ouch!!! – very costly
- If the employee loses time and the claim turns out to be a lost time claim, the adjuster will set the reserves – the figures that raises or lowers your E-mod. If he/she does not remember the Twilight Zone phone calls, one only has to look at the initial file documentation.
- The adjusters tend to reserve the file at 60 days for the lifetime of the file. If the file was introduced to the adjuster with the phone call out of the blue, is there a tendency to put up larger reserves – possibly not. However, if the adjuster notes a trend of late filing, higher reserves are usually the result. I have surveyed hundreds of adjusting , supervisory, and managerial staff. They have all confirmed this point.
- Two years later the employer calls J&L Risk Management on their recent E-Mod spike. Their E-Mod jumped from .89 to 1.43 almost overnight. What was an 11% discount has now turned into a 43% add-on.
The employer’s lag time jumped significantly during that time. Lag time means the days from the injury dates until the insurance carrier receives the First Report of Injury. If one looks at the file notes, Twilight Zone phone calls were very popular, or what would be considered a trend.
Referring back to the Six Keys mentioned earlier, #1 Timely First Reports of Injury is the least costly to fix and/or sustain for a long period of time.
Almost every carrier or Third Party Administrator has an online claim reporting system that should be used for all claims. In fact, quite a few charge extra for claims reported to them on paper.
(R) The Twilight Zone is owned by CBS Television
**Please note the above mini-analysis does not apply in case of litigation.
