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Home » Workers Comp Claims Guide

Workers Comp Recorded Statements – Now A Lost Art?

August 27, 2020 By JL Risk Management Consultants

Whatever Happened to Workers Comp Recorded Statements?

Not too long ago, workers comp recorded statements appeared in every file where the injured worker received any type of weekly comp benefits – a mailed check. 

picture of workers comp recorded statement reel to reel

Wikimedia Commons – Amanda Vincent-Rous

Workers Comp Recorded Statement Requirements

Some of the requirements were: 

  • a recorded statement of the injured employee within 24 hours (even weekends) of receiving the First Report of Injury – unless they were represented by an attorney.  I even took them with the attorney on the phone or in-person
  • preferably in-person if you were a local on-the-road adjuster 
  • a recorded or written statement by any witnesses of the accident as soon as possible (72 hours maximum) 
  • the adjuster used a guide provided by the TPA or insurance carrier.  I still have a flipbook guide somewhere.  I took statements for any type of claim, not just WC. 
  • do not make them confrontational or accusatory 
  • a more involved statement if there was any subrogation potential such as an auto accident 
  • not for medical only claims in most cases 

Written statements were also allowed but they usually ended up being so time-consuming.   When the accident occurred in another state, you could assign an outside firm’s adjuster to take the statement for you if an in-person statement was required.   In-person statements turned out to be much better than over the phone.  

Recorded Statements Faded – 1990s

Black Old workers comp recorded statements tape

Wikimedia Commons – Stilfehler

Workers comp recorded statements reduced quickly in the 1990’s – as did most other lines of insurance.   The last time I remember recorded states being taken was when I consulted for a health and workers comp insurer.   The statements, though, were too accusatory – a written guide and standards were needed at the time.   This was 1996 – yes, 24 years ago. 

Some forward-thinking employers and governmental organizations heavily investigate any type of accident or insurance claim.   I have seen a few written statements taken by these groups.   

Now that I consult on files, I never see recorded statements taken by the adjusters.  Yes, the good adjusters still verify the accident with the employer, employee, and medical treatment facility.   Their three-point contact is performed ASAP.   After all, a claim is basically over in 48 hours – check the link. 

Legality of Recorded Statements

Many times, when I bring this up at conferences or a presentation with claims or risk management department personnel, some of them have responded with recorded statements being frowned up or illegal in their respective adjusting states.   

I usually respond back – then why is a guide for taking written or recorded statements still in your claims adjusting manual provided to adjusters the first day on the job? 

If any carriers or TPA’s are still taking workers comp recorded statements, please let me know in the comments section or let me know at the contact us page.   Thanks.

 

©J&L Risk Management Inc Copyright Notice

Filed Under: Workers Comp Claims Guide Tagged With: 72 hours maximum, confrontational, flipbook guide, frowned up, recorded statements, three-point

Bulk Workers’ Comp Claim Settlements Are Nothing New

January 23, 2020 By JL Risk Management Consultants

How To Set Up Your Own Bulk Workers’  Comp Claim Settlements

One of the major retailers published a news release concerning bulk Workers’ Comp claim settlements.

bulk workers' comp claim settlements groceries aisle pic

Public Domain – Daniel Case

The company had found out that many settlements had one or two sticking points that could easily settle by settling some of the “small things” involved with settlements.   The self-insured retailer called the method bulk Workers’  Comp claim settlements, 

Bulk Workers’ Comp settlements started for me in the mid-1980s.   My supervisor was out for the day when I was a claims trainee.   I did not necessarily get along with my claims manager. 

My bi-weekly claims review was due with my supervisor.  My claims manager decided to do the claims review with me (gulp!).    

At the time, I was an all lines outside adjuster with a heavy claims load for a trainee.  My claims manager decided to cover only Workers’ Comp Claims as I had so many in my claims load.  (Double gulp!!)

One attorney’s name kept popping up in a certain region of my territory in Oklahoma.  Let us call him Attorney Tony.

My claims manager was surprised that the claims supervisor did not share a claims settlement technique that he and my absent supervisor had used very successfully. 

My claims manager told me to print every summary sheet with Attorney Tony.  Call him up and go to the city where he practices with all of my claims summary sheets as long as the injured worker were not still drawing benefits.

In the 1980s in Oklahoma, Workers’ Comp settlements with represented clients were settled by Joint Petition.  If the injured workers’ attorney agreed to the settlement, the Oklahoma Workers’ Comp Commission Courts would approve it. 

My claims manager also informed me not to buy the claimaint attorney’s lunch and do not let him buy mine – separate checks to avoid any appearance of a conflict of interest. 

Attorney Tony was bilingual and had a large number of Spanish- speaking clients in this particular mid-sized Oklahoma town.   I pulled 18 files where his client was finished drawing weekly (Temporary Total or Temporary Partial) disability benefits.  

I circled back to my claims manager that day and said – wait, I do not have Independent Medical Exams (IME”s) for ratings for all the 18 injured workers.  My claims manager said to go to the meetings, raised my settlement authority, and I was to call him, not my supervisor, if I went over my new temporary authority amount.   (Triple Gulp!!!)

Steak Frites bulk workers' comp claim settlements restaurant

Wikimedia Commons – LWY

I called Attorney Tony, and he agreed to meet me at a restaurant with large tables.  I think it was a steak restaurant. 

We met in person the next week with my 18 claims summaries.  I thought – how will I settle these without IME’s.  My bulk workers’ comp settlements had begun in earnest.

Attorney Tony came with no notes.  He knew all of the files by heart – impressive.  He shook my hand and said – “Look, we can spend months with me sending my clients to his usual IME physicians and I could do the same, or we can settle all 18 files today. – What?

Oklahoma allowed PPD Rating stipulations at that time.  I liked the security of an IME to back me up, so I was very hesitant. 

We went through the files one by one.  Attorney Tony said Ok, so for Mrs. Jones, I can get an IME of 15% to the body (45 weeks of benefits), and you can probably get a )0% (no weeks of benefit)s.  Quite a few of these were non-surgical so Attorney Tony said he would stipulate that I had 0% ratings on all of them and then we discussed what rating that I would stipulate to settle and close the file by averaging the ratings.  

We covered 14 files in this manner.  That left four files with posts-surgical  PPD considerations.  The four had ratings from the treating Doctor.

I had to stipulate to higher ratings, and he stipulated to the treating physician ratings or something along those lines.   We hashed those out over the rest of the two-hour lunch. 

Wow, 18 files settled by using a bulk workers’ comp settlement technique first given to me by my claims manager.  

Still yet today, I think that my claims manager had given Attorney a heads-up call that a claims trainee had a stack of files to settle and not to take advantage of my newness.

Eighteen files covered almost 15% of my Workers’ Comp claim file load. 

When I returned to the office the next day, my claims manager called me into his office and asked me how it went with Attorney Tony.   I informed him all 18 files settled with only four having to be hashed out more heavily. 

My claims manager said that we save three to four months and 36 IMEs on those 18 files. 

Petition of bulk workers' comp claim settlements right

Wikimedia Commons – Parliament of England

I could not even remember what I had for lunch; I was so nervous.  My claims assistant had to type up 18 Joint Petitions.  They were not happy as they did take some time to produce for the Court.    The carrier had to type them up, not the claimant attorney. 

After that interesting lunch, Attorney Tony and I would settle files over the phone using the same workers’ comp claims bulk settlement technique. 

My  Quick Guide on Bulk Claim Settlements

  • Follow the rules of your state -you may not be in a state that allows bulk settlements or stipulations.
  • Find the claimant attorney with the most files in your claims load
  • Make some appointment with the attorney, even go to their office or meet for lunch at least for the first time
  • Make sure your usual defense counsel has no reservations about settling the files using this method. They should not if it is legal and proper.
  • Know your claims cold that you wish to discuss. if you are hesitant, you lose
  • Very important — make sure you have the authority to settle. Make sure your claims department is OK with settling claims this way.
  • Do not debate with the attorney
  • If you want to bring along an attorney, that would be OK, but that could change the dynamics.
  • Bulk settlements may not work with certain claimant attorneys. Do not even try it.
  • Buy your own lunch or coffee. Make sure the place has room for any documents you may wish to spread out on the table.  A corner booth works well.
  • If you feel like you are in over your head, call it a lunch or meeting and go back to your office. Do not be intimidated.
  • After meeting in person, you will be surprised at how many files settle quickly over the phone.

 

I wish you good luck with your workers’ comp bulk claim settlements.  Now go settle some claims.

 

©J&L Risk Management Inc Copyright Notice

 

Filed Under: Workers Comp Claims Guide Tagged With: 18 Joint Petitions, attorney agreed, disability benefits, IME, method, newness, stipulations

Workers Comp Claims Savings In 7 Words – Written 8 Years Ago

May 11, 2017 By JL Risk Management Consultants

Workers Comp Claims Savings In 7 Words Reprisal – Still True Today

The Workers Comp Claims Savings In 7 Words articles were very popular when I wrote them.    As with most things in the WC arena, the seven articles still ring true today.  The basics do not change.

picture of workers comp claims savings seven

Wikimedia Commons – Savingsgard

Please excuse the older articles if the spacing or any other attributes look a little off the mark.   The articles still need more “gussying.” 

The 7 Mostly Encompassing Words with a link to each article are:

  1. Report – Check out this article on ASAP reporting from earlier this week – easiest one to accomplish 
  2. Refer – Physician referral control results in cost savings on the medical costs and indirectly saves some of  the indemnity claim costs
  3. Return – A solid return to work program with #1 and #2 implementation will reduce indemnity costs greatly and indirectly the medical costs. 
  4. Treat – If the injured employee thinks they have been treated well, the claims cost reduces quickly.
  5. Document –  Take great notes – always keep any documents handy with a proper records retention policy – back up everything
  6. Question – The old “if you see something, say something” quote applies very heavily.  Asking the proper questions saves cash 
  7. Adopt – If your company does not adopt a program that you have created, #1 – #6 wastes your time. 

The above list was produced in 2010.   I could have easily added another four or five.   Would I change any of the 7 words – No as I wrote up the basis for these in the late 1980s.   Workers Compensation cannot be described as a fluid (ever-changing) environment.    A concept from the past stays true most of the time.  

©J&L Risk Management Inc Copyright Notice

Filed Under: Workers Comp Claims Guide, workers comp costs Tagged With: gussying, implementation, Refer

Workers Comp Claims Guide in 7 Words To Remember

July 8, 2010 By JL Risk Management Consultants

Workers Comp Claims Guide – 7 Words To Remember

A Workers comp claims guide can be broken down into seven easy to remember words. 

I was posting in one of the Workers Comp forums today. I decided to bring over the concept that I posted there earlier today. Let us assume you are just starting to handle Workers Compensation Claims at a certain company. I used seven words and liked the summary.

Professor Workers comp claims guide student

Wikimedia Commons – Wikimedia Finland

They are:

  1. Report
  2. Refer
  3. Return
  4. Treat
  5. Document
  6. Question
  7. Adopt

I am sorry to say this, but I do see quite a few posers at employers that go through the motions without really helping out their Workers Comp situations. That is why I added in the last one – Adopt.  If your company does not adopt some type of Workers’ Comp plan, your program will be akin to traveling without a map or GPS. 

 For our daily blog readers, think about each one and ask yourself if you or someone in your company are doing these tasks. If not, your company is flushing funds down the commode at a rapid pace. Please remember the 400% warning. That will be in the next post.

#1 Report

X Ray Of Hand FROI First Report Of Injury

StocknUnlimited

I thought I would cover some of the Workers Comp mnemonics that the insiders use – people in the claims business. This is the most important document that an employer will ever fill out. The FROI stands for the First Report Of Injury. There are two vendors out there that have a product called FROI services. <<<Update – many now provide this service

I do not want to go into the term much further as it matches up with my other post from today. Two of the most important aspects of The First Report of Injury is that it not only alerts your Workers Comp insurer to a claim, but also gives them permission to act. 

Quite often, Workers Comp adjusters are put on the spot as they have not received the FROI and are asked by a medical provider to authorize treatment.   This is known as the Twilight Zone phone call from the provider to the adjuster.   

I will let you in on a little secret. When it comes time for an adjuster to reserve that file, they remember such things when having to value the claim at the beginning. (Hint)

 #2 Physician Referral

Physical Workers comp claims guide Doctor

Wikimedia Commons – Wesley Carter, U.S. Air Force

The Physician Referral properly done saves workers comp premiums or budget.  .I wanted to cover #2 in The Guide To Workers Comp In 7 Words. This was the original article. There is one instance in time where employers can greatly harm or help their Workers Comp program.

 Refer

 Quite often I hear from employers that their state does not allow the employer to choose the doctor that will treat their employees for their Workers Comp injuries. I always recommend the employer check their Workers Comp rules and regulations very carefully. Some states allow an employer to create a panel of physicians the employee can choose from for their treatment.

 Even if your respective state does not allow the employer to choose the physician, most employees will treat where the employer recommends. That is why it is beyond critical that all employers have established a business relationship with a local industrial-minded doctor or clinic. 

Graphic Of Two Physician Referral Shake Hand

StockUnlimited

The most expensive thing an employer can say is just go to the emergency room or to tell the employee to treat wherever they wish. If the injury is serious, then the employee should always be sent to the local emergency room. 

I always recommend walk-in clinics to our clients as an immediate cost saving measure. There are numerous Workers Compensation clinics that will treat employees on a walk-in basis. I searched our local online directory and found many Workers Comp clinics and walk-in clinics that welcome all Workers Compensation patients. One of the reasons employees with Workers Comp insurance coverage are so welcome is that Workers Comp insurance pays very well for medical services versus other types of insurance.

 The second level doctors are very important. The second level medical treatment involves the more seriously injured employees that are referred by the original treating doctor. The second level consists of orthopedists, orthopedic surgeons, neurologists, neurosurgeons and other types of surgeons. There is nothing wrong with recommending to first level treating physician where the injured employee should be referred if more significant medical treatment is required.

#3 Return (To Work) – Most Important In This Workers Comp Claims Guide

The 3rd of the 7 words for workers comp claims is Return.  From the claims that I have covered, the employer’s Return To Work (RTW) program ranks second behind the medical referral as the most important part of a Workers Comp claim.

Old Workers comp claims guide returning to work

Wikimedia Commons – Robert Garstka

In today’s economy, the risk of a much higher payout is amplified without a RTW program. An employer who does not return employee work risks the employee being ruled as a Permanent Total. These benefits can wreck an E-Mod or X-Mod reduction program by an employer. There are companies such as J&L can help design a RTW program to lower the risk of an E-Mod/X-Mod increased. The task can be daunting. It is worth it.

I have examined, studied, and handled many Workers Comp claims where the employer had a RTW program. The employer without a RTW program will usually pay out over 400% more on their Workers Compensation claims. This number has held true for many years and may even be higher in the current economy.

The first step is to make sure the initial treating physician that your company sends your employees for treatment knows that your company will return employees to work as soon as possible. I am shocked when I see a company that has a RTW program which the treating doctors have no knowledge of when seeing their Workers Comp patients.

#4 Treat

Workers Comp claims cost reduction strategies can be reduced to 7 words.

This post comes from this original post. This s one of the more controversial recommendations that I always make when looking to reduce an employer’s Workers Comp costs. I have often heard from employers that they do not feel like they should be treating the employee nicely if the claim was not legitimate. This has changed over the last few years as I have not heard this as much.

Graphic Of Workers Comp Claims In Icon

StockUnlimited

Treat means how the employer treats the employee from the time they are first injured until the conclusion of the claim. An employer should treat the employee the same as before the accident. An employee out on Workers Comp benefits is still an employee. Terminating an employee while legitimately on Workers Comp leave can increase a claim greatly. A small claim can skyrocket if the claim is deemed to be a permanent total claim. A permanent total claim is much easier to prove if they employee has no return job.

The treatment of the employee by the employer will often avoid the employee becoming represented by an attorney. As we all know, when an employee is represented the eventual cost of the claim increases dramatically. Keeping in constant contact with the employee and letting them know what benefits to expect will avoid the employee seeking legal representation.

 

Communication Workers comp claims guide materials

Wikimedia Commons – Today Testing

The best time to show the employee that the company cares about them is right after an accident happens. As almost every person has an email address, e-card services such as AmericanGreetings.com and Hallmark.com are very good ways to send the employee an e-card when they are injured. It is well worth the effort.

A front office employee should be designated as a Workers Comp Administrator (WCA). This person should be the go-between for the employee’s supervisor, the insurance company’s adjuster, and the employee. This person should also know which physicians or clinics the employee should be sent to for their initial medical treatment.

#5 Document (Everything)

Illustration Of Discussion 7 Words On Table

StockUnlimited

I used to not recommend this one in the past. Now, with so many ways to document an employer’s part of the claim, this has become a critical area of savings. I always say to document as if you as the employer were going to testify what you have written in court.

The other six ways to reduce Workers Compensation claims should be heavily documented. Documenting when the First Report of Injury was filed is important to verify that the claims are being filed timely. The doctor referral and return to work should be documented as you may have to testify to what you remembered in a Workers Comp claim.

A scanner is invaluable to keep track of the document flow. In certain states, the employer can be easily overwhelmed with Workers Comp forms. One of our employer clients keeps a thumb drive for every lost time claim they have in order to keep everything straight. I do not recommend CD’s except as a backup when closing out and archiving a file. Windows-based hard drive systems usually fail every two years. That is why I recommend the thumb drives. You can buy thumb drives that have security on them for about $4 each. That is money well spent.

Picture Businessman Analyzing 7 Words While Sitting on Floor

123RF

One hint to documentation is that the best Workers Comp adjusters are the ones that can document the most in the least amount of space. You can cut corners in documenting Workers Compensation notes if you know what to leave in and leave out.

I have not been able to study the cost saving effects of proper documentation as with the first three terms. One easy way to document your employer files is to access the adjusters’ notes online. I have posted the importance of having online Workers Comp claims access. Often, the adjuster will have all the notes on the development of the claim. I would not rely on this completely, but all the conversations you had with the adjusters will be in their notes.

If you ever have to testify as a Workers Comp witness for the employer, the judges appreciate clear and concise documentation.

#6 Question (Everything)

The sixth term in the list of The Workers Comp Claims Guide in 7 Words is Question. One of the quickest ways to immediately begin reducing Workers Comp costs is to question everything that comes across one’s computer screen or desk.

Employee of Workers comp claims guide Confuse

Wikimedia Commons – Notas de prensa

This means that any bills such as premium bills, premium audit bills, TPA processing bills, policy changes, large settlement request etc. should be questioned. Assuming that something is correct/accurate and just paying the premium or TPA processing bill can cost a company dearly.

One of the documents that should be examined closely is the loss run. As I have posted many times, having online access to your Workers Comp claims is beyond important. The basis for charging your company a premium or a TPA’s processing bill comes from the loss runs.

Loss runs are the best tool to keep your Workers Comp costs down, especially in this economy. If you are reading this and do not know where your company’s loss runs can be located, you are likely throwing away $.

This is not to say that insurance carriers, insurance premium auditors, or TPA’s are dishonest whatsoever. The Workers Comp landscape has become so complicated over the last few years that errors in reserving, premium auditing, billing, etc. do happen.

#7 Adopt 

Graphic Of Suitcase Workers Comp Claims Guide Document

123RF

The #7 Workers Comp claims guide word is adopt.

I had originally began over 20 years ago with the first three of the list and added on #4 – #6 as my experience grew in the area of Workers Compensation. I added ADOPT over the last few months. It is a simple concept that will pay big dividends over the long term.

I can type and type and type my recommendations into this blog for reducing Workers Comp costs. However, if they are not adopted company-wide and from the top > down, they will only be a partial help.

Management must adopt these measures and make them part of the company/corporate culture for them to succeed. I have often see the Safety/Risk Management personnel in a copy become very frustrated as they knew the methods would work. They could not induce the company to adopt these 7 terms/words.

It does take time and effort to make the 7 terms work in a company. One of the most common occurrences is the expectation of immediate results. As I have posted numerous times, the Workers Comp system is a delayed system where the efforts of the present will only become apparent in three to four years.

Using This Workers Comp Claims Guide

You may wish to print out this article or at least save it to your desktop.   If not, I heavily recommend that you memorize the 7 Words to the Workers Comp Claims Guide. 

 

©J&L Risk Management Inc Copyright Notice

Filed Under: Workers Comp Claims Guide Tagged With: forums, legitimate, orthopedists

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James J Moore
Raleigh, NC, United States

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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