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Workers Comp Claims Processing Manual Needs ASAP Theme

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ASAP-Workers Comp Claims Processing Manual

The Workers Comp claims processing manual – ASAP must be built into it from the first sentence .

Graphic Of Computer And Papers Workers Comp Claims Processing Manual At Office
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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.

Medical Personnel Workers Comp Claims Processing Manual Holding Report Notes
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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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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt 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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