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Four Factors That Are Critical When Accident Happens


Four Factors When The Claim Occurs Are Critical

The four factors are:

  1. How was the employee treated by their employer at the time of the claim?

    Vector Graphic of Number Four Factors in Orange Color
  2. 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?
  3. 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.
  4. 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 jumps tremendously.   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 4 PM on a Friday.  Is the adjuster responsible for making 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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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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