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Twilight Zone Phone Calls Avoidance – Timely First Reports Of Injury

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Twilight Zone Phone Calls Reduced By Fast First Reports Of Injury

Twilight Zone phone calls not only irritate a claims staff.   They can also cost plenty at time of policy renewal.

I coined the term Twilight Zone phone calls many years ago.   I have written a few articles on the subject.   Yesterday, in a presentation, I dusted off the old term as it is so applicable to a communications breakdown between all parties involved in a Workers Comp claim.

Girl Making Twilight Zone Phone Calls Old Picture
Wikimedia License

The term refers to a phone call that usually comes in from a medical provider to a Workers Comp adjuster.   You may fill in the blanks at will.

Hello, this is***Medical Provider****.  We have ***injured claimant*** here for ***some type of treatment***.   We were just calling to authorize the  **medical treatment***.   

Now, if the claims department received nothing yet from the employer, the call quickly becomes a Twilight Zone phone call which ends up being very costly.

Bundle of Dollars twilight zone phone calls
StockUnlimited

Costly – Why?   Let us go over the nine main reasons.

  1. The adjuster cannot authorize treatment.   He/She needs the First Report of Injury as that document gives them the legal right to do something on the claim.   Without it, there is no claim – yet.
  2. The medical provider becomes concerned as the injured employee is at their offices.
  3. The injured employee hears all this negative information and thinks maybe I should get some legal advice.
  4. The adjuster then has to stop everything and call the employer to nail down the First Report of Injury filing status
  5. The employer violated #1 of my Six Keys To Workers Comp Savings – Timely First Reports
  6. All the parties in the claim have been introduced in a trial by fire manner.
  7. The initial TTD payment checks run late getting to the injured employee<<<Ouch!!! – very costly
  8. If the employee loses time and the claim turns out to be a lost time claim, the adjuster will increase the reserves – the figures that raise or lower your E-mod.  If he/she does not remember the Twilight Zone phone calls,  one only has to look at the initial file documentation.
  9. The adjusters tend to reserve the file at 60 days for the lifetime of the file.  If the file was introduced to the adjuster with the phone call out of the blue, is there a tendency to put up larger reserves – possibly not?  However, if the adjuster notes a trend of late filing, higher reserves are usually the result.   I have surveyed hundreds of adjusting, supervisory, and managerial staff.   They have all confirmed this point.
  10. Two years later the employer calls J&L Risk Management on their recent E-Mod spike.   Their E-Mod jumped from .89 to 1.43 almost overnight.  What was an 11%  discount has now turned into a 43% add-on.
Picture of Businessman Hand twilight zone phone calls On Telephone
Wikimedia – Pete Souza

The employer’s lag time jumped significantly during that time.   Lag time means the days from the injury dates until the insurance carrier receives the First Report of Injury.   If one looks at the file notes, Twilight Zone phone calls were very popular, or what would be considered a trend.

Referring back to the Six Keys mentioned earlier, #1 Timely First Reports of Injury is the least costly to fix and/or sustain for a long period of time. 

Almost every  carrier or Third Party Administrator has an online claim reporting system that should be used for all claims.   In fact, quite a few charge extra for claims reported to them on paper.

(R) The Twilight Zone is owned by CBS Television

**Please note the above mini-analysis does not apply in case of litigation.

©J&L Risk Management Inc Copyright Notice

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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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