ASAP-Workers Comp Claims Processing Manual
The Workers Comp claims processing manual – ASAP must be built into it from the first sentence .
We often have to examine a carrier or TPA’s claims adjusting manuals while performing our file performance audits for employers. One area that can help to control claims costs is the initial three point contact (Employer, Employee, and Physician).
All the claims manuals properly address the information needed from the three point contact. We sometimes see the manuals requiring that the three point contact be completed within 48 or 72 business hours. This to me is a large mistake as the claim is set in stone approximately two days after the accident.
The carrier that trained me quite a few years in the past would not accept the three point contact not being completed with 24 hours after receiving the first report of injury even on weekends. A claim does not stop because of Saturday or Sunday.
In my opinion, most of the CRITICAL work by the claims adjuster needs to be completed within 24 hours after receiving the first report of injury. The medical treatment can be controlled and the employee can be directed by the employer’s choice of physician if the claim is attended to ASAP. Contacting the employee within 24 hours lets the employee know their claim is being attended to in an expedient manner.
The employer’s responsibility in the process is to report claims as soon as possible and to direct the employee to the proper medical care. The time clock is ticking once the employee reports an on-the-job injury.
A Workers Comp claims processing manual is constructed as an afterthought most of the time. The claims department writes the manual and it then collects dust on the shelf or is an oft-ignored online module.
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