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Report Medical Only Claims To Carrier – Saves Later Headaches


Report Medical Only Claims – The Devil Is In The Delay

Should I report my medical only claims to the carrier?

picture file medical only claims devil
Public Use License – Frank Vincentz

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:

  1. An innocuous accident occurs resulting in a small injury
  2. The employer does not report the claim to their insurance carrier
  3. The injured employee keeps treating and the employer pays the bill or reports it to their health insurer
  4. The claim slowly grows and becomes more serious with little or no oversight – festering like a boil
  5. The injured employee now has incurred multi-thousands in non-fee scheduled bills
  6.  Now, after running up a large claim, the employee starts to miss time from work
  7. The employer decides to report it to their carrier or TPA (self insureds)
  8. The carrier cannot investigate  a claim until the first report is filed
  9. The claims staff becomes frustrated as they likely have received Twilight Zone phone calls
  10. Your reputation has been eroded with your carrier – Oh, it is ABC Widgets, they always report claims late
  11. The adjuster cranks up the reserves much higher than usual due to unseen bills and for the risk of a non-adjusted claim
  12. Claims adjuster now has to play catch up
  13. 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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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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