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Workers Comp Claims Guide in 7 Words To Remember


Workers Comp Claims Guide – 7 Words To Remember

A Workers comp claims guide can be broken down into seven easy-to-remember words.

I was posting in one of the Workers Comp forums today. I decided to bring over the concept that I posted there earlier today. Let us assume you are just starting to handle Workers Compensation Claims at a certain company. I used seven words and liked the summary.

Professor Workers comp claims guide student
Wikimedia Commons – Wikimedia Finland

They are:

  1. Report
  2. Refer
  3. Return
  4. Treat
  5. Document
  6. Question
  7. Adopt

I am sorry to say this, but I do see quite a few posers at employers that go through the motions without really helping out their Workers Comp situations. That is why I added the last one – Adopt.  If your company does not adopt some type of Workers’ Comp plan, your program will be akin to traveling without a map or GPS.

For our daily blog readers, think about each one and ask yourself if you or someone in your company are doing these tasks. If not, your company is flushing funds down the commode at a rapid pace. Please remember the 400% warning. That will be in the next post.

#1 Report

X Ray Of Hand FROI First Report Of Injury

I thought I would cover some of the Workers Comp mnemonics that the insiders use – people in the claims business. This is the most important document that an employer will ever fill out. The FROI stands for the First Report Of Injury. There are two vendors out there that have a product called FROI Services. Update – many now provide this service

I do not want to go into the term much further as it matches up with my other post from today. Two of the most important aspects of The First Report of Injury are that it not only alerts your Workers Comp insurer to a claim but also gives them permission to act.

Quite often, Workers Comp adjusters are put on the spot as they have not received the FROI and are asked by a medical provider to authorize treatment. This is known as the Twilight Zone phone call from the provider to the adjuster.

I will let you in on a little secret. When it comes time for an adjuster to reserve that file, they remember such things when having to value the claim at the beginning. (Hint)

#2 Physician Referral

Physical Workers comp claims guide Doctor
Wikimedia Commons – Wesley Carter, U.S. Air Force

The Physician Referral properly done saves workers comp premiums or budget. I wanted to cover #2 in The Guide To Workers Comp In 7 Words. This was the original article. There is one instance in time where employers can greatly harm or help their Workers Comp program.


Quite often I hear from employers that their state does not allow the employer to choose the doctor that will treat their employees for their Workers Comp injuries. I always recommend that employers check their Workers Comp rules and regulations very carefully. Some states allow an employer to create a panel of physicians the employee can choose from for their treatment.

Even if your respective state does not allow the employer to choose the physician, most employees will medically treat where the employer recommends. That is why it is beyond critical that all employers have established a business relationship with a local industrial-minded doctor or clinic.

Graphic Of Two Physician Referral Shake Hand

The most expensive thing an employer can say is just go to the emergency room or tell the employee to treat them wherever they wish. If the injury is serious, then the employee should always be sent to the local emergency room.

I always recommend walk-in clinics to our clients as an immediate cost-saving measure. There are numerous Workers Compensation clinics that will treat employees on a walk-in basis. I searched our local online directory and found many Workers Comp clinics and walk-in clinics that welcome all Workers Compensation patients. One of the reasons employees with Workers Comp insurance coverage are so welcome is that Workers Comp insurance pays very well for medical services versus other types of insurance.

The second level doctors are very important. The second level of medical treatment involves the more seriously injured employees who are referred by the original treating doctor. The second level consists of orthopedists, orthopedic surgeons, neurologists, neurosurgeons, and other types of surgeons. There is nothing wrong with recommending to first-level treating physicians that the injured employee should be referred if more significant medical treatment is required.

#3 Return (To Work) – Most Important In This Workers Comp Claims Guide

The 3rd of the 7 words for workers comp claims is Return.  From the claims that I have covered, the employer’s Return To Work (RTW) program ranks second behind the medical referral as the most important part of a Workers Comp claim.

Old Workers comp claims guide returning to work
Wikimedia Commons – Robert Garstka

In today’s economy, the risk of a much higher payout is amplified without an RTW program. An employer who does not return employee work risks the employee being ruled as a Permanent Total. These benefits can wreck an E-Mod or X-Mod reduction program by an employer. There are companies such as J&L that can help design an RTW program to lower the risk of an E-Mod/X-Mod increase. The task can be daunting. It is worth it.

I have examined, studied, and handled many Workers Comp claims where the employer had an RTW program. The employer without an RTW program will usually pay out over 400% more on their Workers Compensation claims. This number has held true for many years and may even be higher in the current economy.

The first step is to make sure the initial treating physician that your company sends your employees for treatment knows that your company will return employees to work as soon as possible. I am shocked when I see a company that has a RTW program that the treating doctors have no knowledge of when seeing their Workers Comp patients.

#4 Treat  (nicely)

Workers Comp claims cost reduction strategies can be reduced to 7 words.

This post comes from this original post. This is one of the more controversial recommendations that I always make when looking to reduce an employer’s Workers Comp costs. I have often heard from employers that they do not feel like they should be treating the employee nicely if the claim is not legitimate. This has changed over the last few years as I have not heard this as much.

Graphic Of Workers Comp Claims In Icon

Treat means how the employer treats the employee from the time they are first injured until the conclusion of the claim. An employer should treat the employee the same as before the accident. An employee out on Workers Comp benefits is still an employee. Terminating an employee while legitimately on Workers Comp leave can increase a claim greatly. A small claim can skyrocket if the claim is deemed to be a permanent total claim. A permanent total claim is much easier to prove if the employee has no return job.

The treatment of the employee by the employer will often prevent the employee from becoming represented by an attorney. As we all know, when an employee has legal representation the eventual cost of the claim increases dramatically. Keeping in constant contact with the employee and letting them know what benefits to expect will prevent the employee from seeking legal representation.


Communication Workers comp claims guide materials
Wikimedia Commons – Today Testing

The best time to show the employees that the company cares about them is right after an accident happens. As almost every person has an email address, e-card services such as AmericanGreetings.com and Hallmark.com are very good ways to send employees an e-card when they are injured. It is well worth the effort.

A front office employee should be designated as a Workers Comp Administrator (WCA). This person should be the go-between for the employee’s supervisor, the insurance company’s adjuster, and the employee. This person should also know which physicians or clinics the employee should be sent to for their initial medical treatment.

#5 Document (Everything)

Illustration Of Discussion 7 Words On Table

I used to not recommend this one in the past. Now, with so many ways to document an employer’s part of the claim, this has become a critical area of savings. I always say to document as if you as the employer were going to testify what you have written in court.

The other six ways to reduce Workers Compensation claims should be heavily documented. Documenting when the First Report of Injury was filed is important to verify that the claims are being filed timely. The doctor referral and return to work should be documented as you may have to testify to what you remembered in a Workers Comp claim.

A scanner is invaluable to keep track of the document flow. In certain states, the employer can be easily overwhelmed with Workers Comp forms. One of our employer clients keeps a thumb drive for every lost time claim they have in order to keep everything straight. I do not recommend CDs except as a backup when closing out and archiving a file. Windows-based hard drive systems usually fail every two years. That is why I recommend thumb drives. You can buy thumb drives that have security on them for about $4 each. That is money well spent.

Picture Businessman Analyzing 7 Words While Sitting on Floor

One hint to documentation is that the best Workers Comp adjusters are the ones that can document the most in the least amount of space. You can cut corners in documenting Workers Compensation notes if you know what to leave in and leave out.

I have not been able to study the cost-saving effects of proper documentation as in the first three terms. One easy way to document your employer files is to access the adjusters’ notes online. I have posted the importance of having online Workers Comp claims access. Often, the adjuster will have all the notes on the development of the claim. I would not rely on this completely, but all the conversations you had with the adjusters will be in their notes.

If you ever have to testify as a Workers Comp witness for the employer, the judges appreciate clear and concise documentation.

#6 Question (Everything)

The sixth term in the list of The Workers Comp Claims Guide in 7 Words is Question. One of the quickest ways to immediately begin reducing Workers Comp costs is to question everything that comes across one’s computer screen or desk.

Employee of Workers comp claims guide Confuse
Wikimedia Commons – Notas de prensa

This means that any bills such as premium bills, premium audit bills, TPA processing bills, policy changes, large settlement requests, etc. should be questioned. Assuming that something is correct/accurate and just paying the premium or TPA processing bill can cost a company dearly.

One of the documents that should be examined closely is the loss run. As I have posted many times, having online access to your Workers Comp claims is beyond important. The basis for charging your company a premium or a TPA’s processing bill comes from the loss runs.

Loss runs are the best tool to keep your Workers Comp costs down, especially in this economy. If you are reading this and do not know where your company’s loss runs can be located, you are likely throwing away $.

This is not to say that insurance carriers, insurance premium auditors, or TPAs are dishonest whatsoever. The Workers Comp landscape has become so complicated over the last few years that errors in reserving, premium auditing, billing, etc. do happen.

#7 Adopt

Graphic Of Suitcase Workers Comp Claims Guide Document

The #7 Workers Comp claims guide word is “adopt.”

I had originally begun over 20 years ago with the first three of the list and added on #4 – #6 as my experience grew in the area of Workers Compensation. I added ADOPT over the last few months. It is a simple concept that will pay big dividends over the long term.

I can type and type and type my recommendations into this blog for reducing Workers Comp costs. However, if they are not adopted company-wide and from the top > down, they will only be a partial help.

Management must adopt these measures and make them part of the company/corporate culture for them to succeed. I have often seen the Safety/Risk Management personnel in a copy become very frustrated as they knew the methods would work. They could not induce the company to adopt these 7 terms/words.

It does take time and effort to make the 7 terms work in a company. One of the most common occurrences is the expectation of immediate results. As I have posted numerous times, the Workers Comp system is a delayed system where the efforts of the present will only become apparent in three to four years.

Using This Workers Comp Claims Guide

December 2021 update – workerss compensation insurance has changed very little over the years.  The seven points made in this article still apply even though the article is 11+ years old.

September 2023  and  April 2024 update update – the claims guide has not really changed that much over the years.  This remains more of an evergreen article.

You may wish to print out this article or at least save it to your desktop.   If not, I heavily recommend that you memorize the 7 Words to the Workers Comp Claims Guide.


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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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