by Erin M. Pfeiffer, AIC, Senior Claims Consultant

Taking a backseat to the claims management process can have a devastating effect on the outcome of workers’ compensation claims. The Insurance Information Institute (III) estimates that workers’ compensation medical costs could equal 70 percent of system costs by 2016. This means that claims severity will accelerate relative to today, and claims management will become progressively more difficult and complex.

Ready, Set, Hire

In May, the U.S. Bureau of Labor Statistics reported that the country continued to add jobs for the 27th month in a row, adding 69,000 jobs. Finding new employees will be the trend for many employers, so when hiring, it’s critical that employers implement claims prevention tactics to avoid the hiring mistakes that can lead to injuries, claims and increased workers’ compensation costs. The recommended process is:

• Resume/applicant screening
• Thorough interviews
• Background checks
• Effective drug and alcohol testing done post-offer
• Conditional Offer of Employment: Employment is conditioned upon the candidate being physically able to perform substantially all of the essential job duties of the position
• Post-offer pre-employment exam: Allows medical professionals to screen a hire before they start the job and verify that they are able to perform the physical demands of the job

Make Employees Accountable

Even with the best hiring practices and the strongest of safety cultures, some claims will still be made. But once a workers’ compensation claim is made, there are effective ways to manage it. One of the most effective strategies for an employer to control claim costs are through return to work (RTW) programs. These types of programs have advantages for both employers and employees.

Reports show that RTW programs reduce workers’ compensation costs, deter system abusers, reduce the need to train a replacement and gain work productivity during the medical recovery period. There is also research that supports that employees who return to work in a transitional position are likely to recover more quickly and not become treatment dependent. RTW programs are an important step in employers demonstrating to employees that they are an important asset to the organization. In return, employees feel a sense of self-worth and avoid an interruption of salary and benefits.

Establish a Return to Work Team

By outlining a step-by-step process from the beginning to the end of a claim, employers can minimize the chance of re-injury and enhance the recovery process through productive, modified work. The first step in establishing a successful RTW program is identifying who is responsible for each action item in the claims process. This helps to establish personal accountability and allows for an organization to openly identify where there are claims management gaps. In the RTW program, it is recommended that duties are designated to the following employees:

• Program Coordinator
  The program coordinator facilitates the injured employee’s transition back to work. The program coordinator works with the injured employee’s physician to develop temporary modified work duties during the recovery period, ensuring productivity for the employee until full release.
• Supervisor
  The employee’s supervisor is involved with the documentation process, investigation and future prevention of work-related injuries. In addition, the supervisor is responsible for reaching out to the injured employee through regular phone calls, “get well” cards and flower arrangements, occasional visits and employee invitations to work-related functions.
• Employer Communicator
  A member of the company should be designated as the employer communicator throughout the claims process. The communicator is responsible for maintaining contact with all parties involved throughout the course of the injury, including the employee and their family, employer, internal personnel, the broker, the insurance adjuster and the employee’s physician and therapy facilities.

Develop Functional and Transitional Job Description

Providing a detailed description of all of the essential job duties of each position during the hiring process will help curtail claims down the line. A description should communicate tasks of the job and key responsibilities. It is also wise to include specific credentials or skills necessary to perform the job. For example, if the position involves heavy lifting, this should be included in the job description.

It’s also important to identify temporary transitional positions and to create detailed descriptions of them before a claim is made. An employee able to perform transitional duty can work in this role until he or she has the necessary capacity to perform his or her normal duties. This ensures that employees have meaningful work to do and can continue to be productive members of the organization. To ensure implementation of the RTW program, it is advised to include employees at all levels in identifying potential transitional duties.

Create a Panel of Experts

It’s recommended that employers work with their insurance brokers to establish a panel of physicians composed of medical professionals committed to preventing fraud and abuse. Studies show that teaming up with the right doctors can save money. Furthermore, a well-screened panel of physicians demonstrates to employees that you have their best interest in getting healthy again.

Physicians should be viewed as an extension of the risk management team. It’s recommended that physicians visit the work site to gain a clear picture as to the types of duties performed at the organization and the types of transitional positions available. The physician will only be able to recommend the right transitional job if he or she knows what is physically required to do the job and will be able to specify more accurate absence durations.

Require Open Communication

During the life of the workers’ compensation claim, open communication between the injured worker, employer, medical provider and insurance carrier is paramount to ensuring the most successful resolution for all parties involved. Make sure the physician is instructed to follow up with the business immediately on what transpired at the appointment. This includes the sharing of medical notes between the employer and claims adjuster. This ensures that employers are alerted of any red flags, for example, if the physician suspects the injury was not work-related. Employees should also be required to check in following any medical visits or treatment.