Four Factors When The Claim Occurs Are Critical
The four factors are:
- How was the employee treated by their employer at the time of the claim?
- Did the employer have a medical network established to send the employee to for treatment? Was that employee sent to an established network medical provider?
- How quickly was the Work Comp First Report of Injury filed with the insurance carrier or TPA? Time is critical at this point in the claim. Delays cost money.
- Did the adjuster talk with the employee, employer, and physician within 24 hours of receiving the first report of injury? The immediate three point contact should be a standard in all claim departments.
The clock is ticking when an employee reports an injury. I have studied Workers Compensation claim trends for over 20 years. If #1 – #4 above is not completed in 48 hours, the cost of Workers Comp claims jump tremendously. Actually, 24 hours is even better if logistically possible.
One of the most complicated claims adjuster situations occurs when a first report of injury arrives at 4PM on a Friday. Is the adjuster responsible to make the Three Point Contact the following Monday? The claim does not stop outside of business hours. Investigating the claim within 24 hours remains one of the best Risk Management tools in existence. Medical control becomes tantamount to controlling costs and providing the injured employee with the best medical treatment available.
If the answer to any one of the four above questions is No, your company will be trying to control much higher than normal claims costs and paying at least 1,600% more claims $.
These four factors can make or break a good workers compensation claim investigation. Try to make these four factors work for your company.
Next Up – Payroll (Premium Audits) – the mother of all Workers Comp budget busters
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