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Injured Employee Contact – How Often For Claims Adjusters?

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 Injured Employee Contact Debate – How Often?

In our file reviews, one trend we have noticed since the end of the pandemic is the lower level of injured employee contact by the claims adjusters.  Could it be the subset of claim files that J&L reviews do not represent claims adjuster contact for all workers comp files?

Yes, but the trend of not contacting unrepresented employees has occurred since I started adjusting WC files long ago – in the mid-1980s.   in the old horse and buggy days, an adjuster only had a phone.  The days of personal email were just starting with no smartphones.

My claims manager would require us to file injured employee contact logs for review.  She felt that the adjusters including me dreaded calling the injured employees.  The claims manager was correct.  Approximately 1/3 of the injured employees would contact me directly.  Those counted on my logs even though I did not initiate the call.

pic of telephone injured employee contact
Public Use License -ArnoldReinhold

Three-Point Contact Gets The Ball Rolling

Three-point contact (Physician, Employer, Employee) remains a super-critical time for 24-hour contact.  Many files I have seen over the years do not have documentation that indicates any injured employee contact.  No phone call is made and a letter is mailed to the injured employee.  As my claims manager used to say, “That will be something for the employee’s attorney to read” when they receive it.

In other words, calling the injured employee is a great way to let the employee know that someone is working on the file and their employer has filed all necessary forms timely.  I used to dread the first reports of injury (FROI) coming in on Friday afternoon, but a lot can happen between Friday afternoon and Monday morning without the injured employee contact upon receipt of the FROI.

The initial call is a great time to take a recorded statement if necessary.  Some carriers and TPAs require recorded statements.  Some leave it to the adjuster’s discretion.

Establishing a working relationship with the injured employee at the very beginning usually results in a lower claim value and has a bit of a customer service element to the injured employee and insured.

After The Initial Conversation

I was reviewing a set of files for an agency earlier this year.  I noticed one outstanding adjuster for a TPA in Arizona.  Matt made the injured employee contact by calling them at least every 21 days.  His files closed quickly and for a comparably lower claim value than the other adjusters in the set of files from the same TPA.   One area that made him stand out – documentation.  He would document the conversations to the nth degree.

Matt also returned any phone calls within 24 hours – even if he had to stay after hours on a Friday to make sure the calls were made and not allowed to fester over the weekend.

Emails are great but the human element is taken out of the equation.  We all receive hundreds of spam emails weekly if not daily.   The one nice component of emails is self-documentation.

Many carriers and TPAs supplement the injured employee contact with a login ID and password for the injured employee to follow their claim.  If an injured employee can see if a payment was made or treatment was authorized, phone calls and emails are reduced quickly.

If there is nurse triage or a field case manager on the file, an adjuster may not need to contact the employee as often if there is no case management or triage on the file.

Injured Employee Contact No-Gos

One area  I have seen in files over the years that should never be broached is talking with represented employees – even to verify that a medical or weekly benefit payment was made on the file.  I had made this mistake many years ago.  A letter from the employee’s attorney to my claims manager made sure that I never did that again.

The other area is text messaging.  I handled a small group of files where I gave the injured employees my personal cell phone number.   Most of the files were seriously injured mega claims.   Injured employees will text you at 3 AM without hesitation.  I learned my lesson quickly.

The Secret Guide For Injured Employee Contact

What document aids all claims adjusters in the area of injured employee contact?  Do not tell anyone this secret.

It is called the Claims Processing Manual which all claims adjusters are paid to review when they start with a new carrier or TPA.  Look up the Employee Contact section.  This manual will spell out what the carrier or TPA expects the adjuster to do in the area of contact.  Please do not use anything in this article that may be different than what is in the manual.

In fact, even Senior Adjusters should dust off the manual and review it.  One can never go wrong with following the instructions in the manual.  I have written almost 10 claims processing manuals from scratch that seem to not receive even a glance from the adjuster trainees to the Claims Supervisors.

Knowing your claims handling manual beyond the employee contact instructions will always save you many future headaches.  Do not end up like me having my Claims Manager read me a letter from the employee’s attorney.

Notice that I do not call an injured employee a claimant.  Yes, they are making a claim for benefits but the injured employee or injured worker phrase looks so much better in the file documentation.

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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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