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Workers Comp Claim Action Plan- Online Access Answers 100+ Questions

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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.

graphic of workers comp claim action plan global
Public Domain – Wikimedia

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.

  1. Injured Worker Name
  2. Adjuster Name and Contact Info
  3. Date and Time of Action Plan
  4. Diary Review
  5. POA
  6. Indemnity Benefits
  7. Medical Benefits
  8. Maximum Medical Improvement Date
  9. Anticipated Return to Work Date
  10. Released from Medical Care Date
  11. File Closure Target Date
  12.  Any outstanding forms that need to be filed with the State
  13. Any outstanding issues that may affect any target dates
  14. Current Status – very important to avoid phone calls 
  15. Payment of benefits
  16. Addressing Modified Work availability
  17. Injured employee contact information – usually an email address
  18. Supervisory Review – great to see in files, not always there – usually a re-review of the adjuster’s workers comp action plan
  19. Communication between supervisor and adjuster on diary dates
  20. The adjuster’s description of accident in their own words – important 
  21. Compensability – another very important question answered
  22.  Reserves – Why are the amounts on the file (Total Incurred)
  23. Amounts of Indemnity Total Incurred and Reserves on the file.
  24. Amounts of Medical Total Incurred and Reserves on the file.
  25. Amounts of Expense Total Incurred and Reserves on the file.
  26.  Amount of Rehabilitation that may be spent on the file – think Rehab Nurses
  27. Are Medical Networks being used properly?
  28.  Was the coding of the claim variables input properly?
  29. Full Medical Update including recent physician visit and the physician’s note
  30.  How and if Medical notes address light-duty ad full Return to Work
  31.  Work/Employment Status – this is covered often in most files
  32.  How Average Weekly Wage was calculated and Anticipated Temporary Total Disability TPD,  and PPD payments
  33.  Alert to all parties – Analytics data such as background of employee, such as the personality of the injured employee, drug or alcohol use, etc.
  34.  Current litigation status
  35.  Settlement Value – if applicable
  36.  Social Security considerations/Medicare
  37. Results of the Index Report – usually do not see this in a Workers Comp Action Plan
  38. Subrogation – one of my big concerns in Workers’ Comp claims
  39. Coverage – the correct policy applied?
  40. Any special reporting requirements for the employer/client insured?
  41. Settlement reserve authority 
  42. 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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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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