Effective management of your workers’ compensation program can lead to multiple benefits, including a decrease in lost-time claims, reduced frequency of claims, a lower experience modification rating, and ultimately, lower workers’ compensation premiums.
Most of my articles have focused on ways in which you can proactively manage your risk management process. All too often, employers are quick to release full control of the claims process to the insurance carrier, who may have conflicting interests. To truly own the process and reap the benefits, you must maintain control of the process, and the best way to do that is to consistently follow a written claim policy. If you don’t have one or want to refresh yours, here are some things to consider:
Complete a First Report of Injury (FROI) form
The injured worker’s supervisor or human resource manager should do this immediately. It is especially vital to complete a timely and thorough accident investigation, including witness’s statements, if any. The accident investigation should result in a detailed description
of the accident, analysis of the cause and corrective actions to take to avoid similar accidents in the future. This document establishes the facts about the claim and businesses are smart to gather that information as quickly as possible as the “facts” get lost with the passing of time.
Ensure the employee is receiving appropriate medical care
If possible, provide the injured employee with a detailed job description, your available light-duty accommodations and a Return-To-Work-Authorization form to give the medical provider. The job description helps the medical provider understand job specifics so any applicable work restrictions will be tailored to the position. The light-duty accommodations or your Return-To-Work program details give the provider knowledge so that a release to return to work with restrictions may be more readily made and the injury will more likely result in no lost time. The best case scenario is to have a member of your management team accompany the injured employee on their medical visit and deliver the documents to the health care provider in person.
Provide meaningful light-duty work when an employee returns
This is important for a recovering employee and a positive approach to improving the employee’s well-being. Remember, though, that light-duty accommodation should not become a permanent solution.
Monitor and apply transitional work consistently Open, honest and ongoing communication will resolve many problems; therefore, it is beneficial to communicate regularly with the injured employee with a caring attitude about their recovery, restrictions, light-duty position and follow-up appointments. Besides helping you better manage the claim, this can also boost an injured employee’s morale. Often it is not the medical condition that keeps an injured employee out of work, but the relationship, or lack of relationship, with the employer or immediate supervisor! Thus, demonstrating concern and care for the injured employee and their health is critical.
Document transitional work performed
To ensure that the injured employee is working within the restrictions provided by the medical doctor, you may consider creating a document that both the injured employee and supervisor sign off on at the end of the shift stating that the work was within the provided restrictions. If an injured worker is found to be inadequate in the temporary role, discuss the importance of the
work restrictions and commence disciplinary actions if disobedience persists. Warnings will help justify the corrective action if they are not heeded. Remember it is critical to document all actions.
Build relationships and communicate directly with health care providers
You may invite the treating doctors to your facility and give them a tour so they can better understand your work processes. When an injured employee remains authorized off work for an extended period of time, this direct communication and relationship can be especially helpful because you and the health care provider can better work together to improve the worker’s health. Unless your health care provider has toured your operation first hand and understands what is required of your workers and your light-duty-return-to-work program, you can be certain that work recommendations and restrictions prescribed by the treating health care provider will not be in sync with your efforts to accommodate injured workers. Ultimately, you will experience longer durations of loss time claims if your health care provider operates without first-hand knowledge of your operations and expectations.
Although the Workers’ Compensation claims process can be frustrating and complicated at times, you can always rely on the expert knowledge of your insurance carrier and/or agent for assistance and advice. Moreover, as self-management of your claims process continues, measure the successes and failures, and adjust your procedure as necessary. Eventually, the benefits of taking ownership of the claims process will become evident.
Content provided in conjunction with Marsh & McLennan Agency’s
Claims Consultant, Cassandra Rudy.
For more information, contact the claims department at Marsh & McLennan Agency at (800) 444 -3033.