Report Medical Only Claims – The Devil Is In The Delay
Should I report my medical only claims to the carrier?
Our newsletter and blog readers ask us this question as often as any other workers comp question. The other related question – Will my premiums increase if I report medical only claims?
Our answer is – Not reporting medical only claims will increase your premiums in the long run. A side note – most states give a 70% discount to the effect on your E-Mod when you report your medical only claims.
Claims Festering Due to Not Reporting Medical Only Claims
Claims festering was coined by me approximately 10 years ago. When an employer decides to become the adjuster on small claims, the scenario proceeds along in this fashion:
- An innocuous accident occurs resulting in a small injury
- The employer does not report the claim to their insurance carrier
- The injured employee keeps treating and the employer pays the bill or reports it to their health insurer
- The claim slowly grows and becomes more serious with little or no oversight – festering like a boil
- The injured employee now has incurred multi-thousands in non-fee scheduled bills
- Now, after running up a large claim, the employee starts to miss time from work
- The employer decides to report it to their carrier or TPA (self insureds)
- The carrier cannot investigate a claim until the first report is filed
- The claims staff becomes frustrated as they likely have received Twilight Zone phone calls
- Your reputation has been eroded with your carrier – Oh, it is ABC Widgets, they always report claims late
- The adjuster cranks up the reserves much higher than usual due to unseen bills and for the risk of a non-adjusted claim
- Claims adjuster now has to play catch up
- The claim is out of control – get out the checkbook
The same scenario occurs with a self insured except you do not wreck your E-Mod, you wreck your budget for claims payments.
Six Keys for Savings
Reporting claims timely remains one of our most highly recommended keys for cutting workers comp costs. My advice is to report any claim where the employee has to stop work due to an injury. If the injured employee receives medical treatment, then they had to stop work and seek out medical care.
With online reporting, filing the first report of injury is now easier and faster. I can still remember when the fax machine hummed from incoming claims.
The bottom line – report medical only claims to your carrier.
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