Reportable Only Claims Save Thousands Of Dollars
The reportable only claims may be a term you have never heard of in Workers Comp. Reportable only claims can save thousands of claim dollars down the road. Let us look at how these claims work, even though the word claims may be a misnomer for this type of under-the-radar claim.
What Are Reportable Only Claims?
Reportable only claims occur when even though the injured employee seeks no medical treatment and does not leave work due to an on-the-job incident. A very wise employer reports the claim to their insurance carrier or TPA (if self-insured).
The concept sounds simple. The paybacks are great. Most insurance carriers do not open these claims up with any type of reserves. TPAs for self-insureds do the same thing..
I see these claims all the time when performing loss run reviews. The claims designations are RO or Report Only. Letting the carrier know of a claim that may never amount to more than a line on a loss run often reaps benefits later.
An Example
Let us say that an employer has properly reported an incident as a reportable only claim. An injured worker reports that they felt a twinge in their shoulder while lifting a wooden pallet and reports it to their supervisor.
The supervisor wisely reports the incident to whoever files the first reports of injury to the carrier. The claim is sent to the carrier as a reportable only claim.
The insurance carrier sets the claim up as a reportable only with no further action. Two weeks later, the injured employee decides to seek medical treatment, and the adjuster receives a twilight zone phone call from a medical provider. Two different scenarios are:
- The adjuster sees a reportable only claim was filed two weeks prior and can authorize or decline treatment. The claims adjuster knew ahead of time what had occurred with the injured employee’s shoulder. Adjusters making informed decisions always mean lower claims dollars spent and the all-important employer reputation with the adjuster is preserved. Having a good reputation with the claims staff means lower reserving. The adjuster sets the claim with $500 in medical only claim reserves.
- The claims staff receives a phone call from the same medical provider, where no first report of injury was filed by the employer. The adjuster has no idea who the injured worker is and has to turn the worker away or have them wait until they can receive a first report of injury. By then, the medical provider, the injured employee, and the claims staff are not happy with the situation at hand. The adjuster then sets the reserves at $50,000 at file opening.
The Why
The claims math tells you that $49,500 extra in reserves were set by the claims adjuster. This example may be an extreme case. Any claims adjuster will tell you that they see this happen all the time. Why the $49,5000 difference in reserves occurred can be attributed to risk.
A twilight zone phone call was due to not filing a reportable only claim with the carrier. No adjuster likes to be the last one to know about the claim. Higher perceived risk = higher reserves.
When To File Reportable Only Claims
Check with your insurance carrier or TPA to see the best method to file reportable only claims. Make sure that the words Report Only appear somewhere on the First Report of Injury document. Take the time to file what seems to be minor. A carrier’s online claims reporting system usually contains a guide. Some carriers may charge a tiny fee to file the claim – worth the time and effort.
