Medical Only Claims Misclassification – The Worst We See
What is workers comp medical only claims misclassification? Why do those claims turn out the worst?
Medical only claims misclassification occurs during the reported claims intake process. When a claims department receives the First Report of Injury (FROI) that looks like a medical benefits-only claim, the claim can easily go into the low-priority pile.
One carrier I worked for at the start of my career required a phone call to the employer on every FROI received within 24 hours. No differentiation would be made between a potential lost time claim and a medical only claim.
This method of FROI investigation may seem obsessive. The carrier avoided the dreaded medical only claim festering.
When a lost time or major claim becomes a medical only claims misclassification and the carrier generates no follow up actions, these claims usually turn out the worst. No adjuster or employer controls exist – and worst of all the injured employee may not receive the level of medical care they need to return to gainful employment.
Medical only claims misclassification stops the following claims handling process. Most lost time workers comp claims become set in stone within 48 hours after a claim occurs – why?
- The employee has reported the claim to their employer. Trust of the employer by the injured employee becomes critical.
- Some type of medical treatment has occurred whether employer-directed or employee choice
- The claims department has received the claim
- The injured employee has been written out of work
- Without the adjuster’s quick action, the direction of the claim becomes almost random
Avoiding Claims Festering
When I first heard our Claims Manager instruct us to call on every claim received, I rolled my eyes and was later admonished for the eyeroll.
The sledgehammer method of calling on every claim avoided the dreaded medical only claims misclassification. The effort avoided having serious claims overlooked by the lost time adjuster.
Time is of the essence when FROIs are received.
