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Workers Comp Claim Files Missing One Important Easy Task

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Workers Comp Claim Files – Three-Point Contact Disappeared

One task that workers comp claim files need has seemed to disappear over the years.   Most adjusters can make their lives much easier by accomplishing this one task upfront.   In the 13 workers comp adjuster everyday to-do list, this has to be the most important one except to pay weekly benefits.

The easy task that takes just a few minutes to accomplish is three-point contact.  Back in the 1980s and 1990s, not only was the contact required within 24 hours (even on Fridays), a recorded statement of the injured worker was an additional add-on task.

picture stabilizing factor magician workers comp claim files
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Some carriers and Third Party Administrators still require recorded statements.  As always, and for any recommendations that I have given – check your claims manual on how to handle three-point contact.

Contacting the treating physician, employer, and injured employee within 24 hours after receiving the first report of injury (FROI) will save time and avoid later headaches.

Of course, if the employee is represented by an attorney, one cannot contact the employee, but at least the adjuster can call their attorney’s office and at least talk to a paralegal or assistant.  Some states do not allow contact with the physician without the injured employee’s permission.

Most adjusters do contact the employer, then send the injured worker and physician a letter.

Workers Comp Claim Files – The Most Important Key

The adjuster is the communication hub on the file.  Making the three-point contact on any workers comp claim files may seem to be an overwhelming task with the other daily duties.

hand on phone workers comp claim files making phone call
Public Domain – Pete Souza – White House Flickr account

Establishing a working relationship with all three main parties on the file makes the file progress more easily.   The initial three-point contact can help start the relationship.   As I write this article, I realize that adjuster turnover remains very high during the pandemic.  The turnover generates a time crunch to accomplish this task.

The best way that I recommend for contact is with emails once the initial “hello call” has been made within 24 hours.  This makes file documentation much easier without having to type a record of a phone call.

My 3-3-3 contact recommendation keeps things short and to the point.

How do I come upon the lack of three-point contact?  When I review workers comp claim files for agencies, carriers, TPAs, attorneys, and state governmental entities.   If anyone has questions on how to accomplish the 24-hour contact, you know where to find me.

 

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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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