Workers Comp Claim Action Plan – Online Access Answers 90% of Questions
Most Workers Comp Claim Action Plans cause the adjusters to have to do a ton of work. Long ago, when I was a full-time adjuster, I looked forward to closing out a file so that I did not have to do any more claim action plans.
Workers Comp claim action plans still result in a large amount of work for the adjusting staff, even with the advances in technology.
Any outside parties to the claim (agent, consultant, employer, reinsurer, etc.) should relish the plan of action. Why?
Any of the persons in the above parentheses can avoid calling an adjuster by simply getting online and look for the workers comp action plan to find answers to their questions.
I did not want to copy a recent workers comp claim action plan as too much data had to be redacted due to privacy concerns. Below is a list of questions you can answer from a POA (Plan of Action). Most Workers Comp Action Plans originate with a template.
- Injured Worker Name
- Adjuster Name and Contact Info
- Date and Time of Action Plan
- Diary Review
- Indemnity Benefits
- Medical Benefits
- Maximum Medical Improvement Date
- Anticipated Return to Work Date
- Released from Medical Care Date
- File Closure Target Date
- Any outstanding forms that need to be filed with the State
- Any outstanding issues that may affect any target dates
- Current Status – very important to avoid phone calls
- Payment of benefits
- Addressing Modified Work availability
- Injured employee contact information – usually an email address
- Supervisory Review – great to see in files, not always there – usually a re-review of the adjuster’s workers comp action plan
- Communication between supervisor and adjuster on diary dates
- The adjuster’s description of accident in their own words – important
- Compensability – another very important question answered
- Reserves – Why are the amounts on the file (Total Incurred)
- Amounts of Indemnity Total Incurred and Reserves on the file.
- Amounts of Medical Total Incurred and Reserves on the file.
- Amounts of Expense Total Incurred and Reserves on the file.
- Amount of Rehabilitation that may be spent on the file – think Rehab Nurses
- Are Medical Networks being used properly?
- Was the coding of the claim variables input properly?
- Full Medical Update including recent physician visit and the physician’s note
- How and if Medical notes address light-duty ad full Return to Work
- Work/Employment Status – this is covered often in most files
- How Average Weekly Wage was calculated and Anticipated Temporary Total Disability TPD, and PPD payments
- Alert to all parties – Analytics data such as background of employee, such as the personality of the injured employee, drug or alcohol use, etc.
- Current litigation status
- Settlement Value – if applicable
- Social Security considerations/Medicare
- Results of the Index Report – usually do not see this in a Workers Comp Action Plan
- Subrogation – one of my big concerns in Workers’ Comp claims
- Coverage – the correct policy applied?
- Any special reporting requirements for the employer/client insured?
- Settlement reserve authority
- All information collected on employee including address and contact information (a large amount of background data from claim inputs)
I have combined many of the answers to the questions that anyone may have about the workers’ compensation claim. Now, I think we can see the value of online access. The above Workers’ Comp Action Plan covered six pages for an injured worker that was out of work for four weeks and will have no permanent disability.
Calling the adjuster vs. online access to the Workers Comp Action Plan = Six Hours of Worked saved.
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