Why Is Workers Comp Claims Alarm Clock Set For 48 Hours?
Why does the Workers Comp claims alarm clock go off after 48 hours? Let us look at one of the tried and true rules that I invented for a speech back in 1988. A group of four adjuster trainees, of which I was one who was tasked with doing a presentation as part of the initial training.
Before that time, I was an all-lines field adjuster in Oklahoma. I noticed that the Workers Comp claims alarm goes off after 48 hours, not business hours, but 48 hours.
I decided to do my presentation on the bad things that can happen when an adjuster takes longer than 48 hours to finish the investigation and compensability determination. Another complication comes from the lag-time that an insured takes to report the claim. I have also spoken on the subject of lag time to report claims at many conferences and in recent Zoom presentations over the years.
Friday Evening Paradox
That meant if a claim came in on Friday at 4 PM, one had to do the initial investigation over the weekend. You could not wait until Monday morning. The claims manager always wanted the full investigation (3- point contact) finished in 24 hours. I did not like having to work Friday evenings or on Saturdays, but that was the office rule. The 24-hour rule now makes perfect sense.
Using the thoughts from my ancient adjuster-trainee presentation, let’s cover what occurs by the time the Workers Comp claims alarm clock begins buzzing.
Steps to the Workers Comp Claims Alarm Clock Buzzing
First, we need to cover the Workers Comp claim process at the beginning
The injured employee:
- Has sustained an accident/incident
- Reports the claim to employer
- Seeks medical treatment
- Now waits to hear from someone, as they cannot work on their future
- Has developed first impression attitude that is hard to change
- Workers Comp claims alarm goes off – 48 hours and claim is set, claim is out of control
- Is contacted by the claims adjuster
The claim is usually much more expensive in this example.
How It Should Have Happened
The injured employee:
- Has sustained an accident/incident
- Reports claim to the employer
- Sent to medical treatment that has been pre-established, for example – treatment network
- Claim reported immediately to claims staff
- Is contacted by the adjuster
- Feels that needs are being met.
- Claims control stops the 48-hour alarm from going off
When the time comes for a return to work determination, the second example usually causes a smooth transition, especially if the employer can offer a light-duty job that fits the treating physician.
Bottom Line
The need for speed becomes critical once an on-the-job accident occurs on each claim. The workers comp claims alarm goes off in 48 hours. Were you able to beat the clock? If not, be ready for a probably unhappy injured worker.
