In our last segment, we discussed how important the “Pre-Claim” process was to your bottom line relating to some policies and procedures that should be in place before you sustain your next Workers’ Compensation claim.
The fourth step in the “4P” plan is known as the Post-Claim step. At this stage, you should be asking yourself this question, “What policies and procedures should we have in place when we have our next Workers’ Comp claim?”
Most everyone knows that when you have your next Workers’ Compensation claim, you must report it immediately to your insurance carrier. One thing you may want to keep in mind is that some states, such as Florida, are considered “fee scheduled” states. This means that for any medical service that is performed that is deemed to be a Workers’ Compensation injury, the medical facility can only charge you the state-mandated fees based upon the type of injury. These fees are typically much less then they would charge for a non-Workers’ Compensation injury. Bottom line, make sure you let the medical facility know that you’re filing a Workers’ Compensation claim, and be certain they charge you the lower Workers’ Compensation fees from the fee schedule.
In the event of a claim, the employer can have a dramatic positive impact on the cost of their claims — reducing the claim by as much as 70% — by making sure they have collected the proper documentation and provided it to the carrier claims adjuster within the first seven days of a claim.
First and foremost, make sure your company uses a detailed accident investigation form on all claims. This form should be completed by all parties to the claim: the injured worker, witnesses, their supervisor and management.
You should also provide the adjuster with the Medical Health questionnaire and job descriptions we mentioned earlier. Chances are an employee will have an injury which may be related to a prior injury they have sustained. To help speed up the process, arm the adjuster with a medical release so they can retrieve prior medical records in doing their research on the claim.
At the time of the claim, you should provide some information to the adjuster relating to what are called “Red Flag Indicators” and “Route Cause Analysis” information. This will not only help the adjuster in mitigating the cost of your claim, but can be an excellent tool to help you seek out relevant training for loss trends your company may be developing.
Having the proper documentation in the hands of the adjuster in the first seven days will go a long way toward re-tooling their time to be more effective in lowering your claim costs and toward avoiding clerical delays which could end up costing you money.
What some will tell you is that the most important part of the Post-Claim process lies in how you deal with your injured employees. If, for whatever reason, you’re just not comfortable with the viability of the claim and it’s just not passing the “smell test” for you, heed these four words: “Kill them with kindness.” Studies have shown that time after time, if an employee feels you do not care about them, they will seek outside legal help on their claim which will increase the cost to your claim, further stealing your profits.