Workers Comp Medical Only Claims And Claims Festering(c)
Certain Workers Comp Medical Only Claims snowball into uncontrolled Lost Time Claims for employers and carriers. My last post on Medical Only claims pointed out the pitfalls and concerns of medical only claims. I promised that I would get back to how employers should monitor medical only claims.
One of the huge mistakes by employers and carriers is the medical only claims are allowed to fester for many weeks and months and not receive the proper attention. I have seen many medical only claims turn out to be an employer’s worst nightmare.
A medical only claim has really had no investigation performed and is usually more of a medical only claim processor’s job. A lost time adjuster may never see a medical only claim until it turns serious, such as a physician’s office calling for authorization for a major back surgery. By that time, it is almost too late to do anything that would resemble a good investigation of the claim.
Medical only claims are not that hard to monitor. Avoiding a delayed investigation by the Workers Comp adjuster is the goal.
An Excel spreadsheet can be used as a diary system. An Outlook or some type of calendar program will work even better. After filing the First Report of Injury for a medical only claim, calendar a follow up with the employee at 30 days, 90 days, 6 months, and one year. If they have an email address, that is the easiest method to contact them.
The others side of the coin, so to speak, is what info is flowing to your insurance carrier or TPA without your knowledge. Medical providers often send the bills and reports directly to the claims office. You should ask that a copy of the medical bills and reports are also sent to your office. If the report points out the employee’s condition is worsening or surgery is anticipated, you will be able to point this out to your Workers Comp claims department.
One of the most heavily posted recommendations by me is having online access to your claims. You can easily see what is occurring in the claim and to see how the carrier is handling the medical only claims. You may also be able to see scans of the medical reports or medical charges paid.
Using these two simple techniques will avoid you surprising your claims adjuster. Do not rely solely on your Workers Comp claims department to catch everything on medical only claims. A surprised claims adjuster may set your Workers Comp reserves very high, which means your E-Mod will be higher, which is money down the toilet.
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