Top 5 Things to Consider: Workers’ Comp Claims

Five Things Blog revised

Handling workers’ compensation claims is detailed and complex. From start to finish, there are many factors to consider. In most instances, employees must immediately seek medical attention and notify their employer of their injury. This is important because workers’ comp claims are time sensitive. Claims must be acted on promptly in order to meet statutory reporting requirements and make timely compensability determinations. Employers are responsible for filing workers’ comp claims with their insurer. The insurer is responsible for filing claims with the state workers’ comp bureau. This can be the filing of a form, the transmission of data via an electronic data interface or a combination of the two. With all of the details and steps involved in submitting, investigating and adjudicating workers’ comp claims, it can be challenging for employers to understand the nuances of the claim and the jurisdiction. So here we will identify some important points that employers need to consider regarding the workers’ comp claim process and understand how they play a part in getting injured workers back to work.

Complexity

  • Workers’ compensation claims are more complex now than they were in the past due to a variety of issues including:
    • The complex regulatory environment
      • Each jurisdiction has its own unique set of regulations
      • Federal statutes protecting Medicare must be taken into consideration
    • Medical treatment and medication management is challenging, as these two areas are constantly evolving
    • The aging workforce creates challenges such as:
      • The length of time it may take for an injured worker to recover from an injury
      • The impact pre-existing and comorbid conditions have on recovery and the cost and ability to
        return to work

Expertise in handling claims

  • Specialized expertise claims handling models are needed to achieve optimum claims outcomes
  • A team-based approach allows for the assignment of the right claim to the right claims professional

Specialization matters

  • An organization needs to have the expertise and specialization in workers’ compensation claims that extends well beyond claims handling. It includes areas such as underwriting and risk control

Wellness program

  • Employers should implement a robust wellness program, which can help to minimize workplace injuries and reduce duration of disability

Communication & personal touch matter

  • Employers need to be proactive by reaching out to injured workers to keep them connected to their employer and their jobs
  • Injured workers want to know that their employers care and have empathy
  • Implementing return to work programs
    • Employers need to have a return to work program that allows injured workers to return to work on a modified duty basis
    • This means that the injured worker has the option to return to work on a part-time basis rather than full-time or to a modified position that allows them to return to work with physical limitations
    • Doing so may help injured workers return to work sooner and reduce the overall cost of the claim

Employers should take all of these important factors into consideration when managing their workers’ compensation program. Though the process can be complex, employers can manage it through a strong partnership with their insurer by making certain that they have all of the information needed for claims to be managed effectively and efficiently. Implementing wellness programs in combination with robust return to work programs and proactive claims management can improve outcomes for employers and injured workers. For information on PMA’s claims services, visit our website at https://www.pmacompanies.com/claims.

Ray DiCello, Senior Vice President

Ray is the Senior Vice President and Chief Claims Officer of PMA Companies. He is responsible for all aspects of PMA’s multi-line claims services operations.