Risk Management & Insurance Program

Workers Compensation Claims Management Tips

When you have a claim occur, your insurance company is ultimately responsible for the payment and resolution of the claim for the injured employees; however, there is no substitute in effectively resolving a claim over immediate personal involvement by you!  Stay involved in your claim, regularly communicate with your adjuster and retain contact with you injured employee.

To report a claim, click here.

We have developed a Claims Management tool that you can download to assist in the process of managing your claims effectively.  Click here to download this document.

There are a number of key steps you can take to help effectively manage your claim and to mitigate the expenses once a loss occurs.  Some of these steps include the following:

1. The Role of Your Claims Adjuster – A common misconception related to Workers Compensation claims is that once you file your claim, you don’t need to worry about it any further.  Nothing could be further from reality!  We highly encourage our members to have routine contact with their claims adjusters (assuming there is claims activity) and to stay very involved in the resolution of your claims.  This especially applies if there are “issues” on the claim that might prompt careful observation of the situation.  For our clients that have a particularly high claim count or for those who have significant open claims, we recommend that we have periodic claim reviews with you and the adjuster.  Ask your Account Executive for more information if you think you would benefit from a periodic claim review.
2. Three-point contact within 24 hours of notice of injury – The insurer will contact the injured employee, the physician, and the employer within 24 hours of the report of an accident.
   • Employer – to confirm the details of the accident
   • Injured Employee – to gather information about the injury from their perspective and to coordinate the future process of helping them return to work
   • Physician – to confirm the details of the injury and the plan for treatment and return to work
3. Investigate questionable claims and deny claims where appropriate.  Insurers will notify you of their plan to deny coverage for a claim.
4. Support our Transitional Return-to-Work program and help create modified job duties to assist in getting the injured employee back to work.
5. Drug Testing – Various levels of drug testing are available and encouraged, but post-accident drug tests give the greatest return on investment.  The post accident drug test often will be paid for by the insurer.
6. Insurers will index claims to be sure that the amount paid is limited to compensability standards.
7. Loss Reporting – Loss runs should be routinely reviewed.  To request loss runs, click here. If you would like to automatically receive loss runs at a selected interval, let your Account Executive know.
8. Physician Partnerships – A partnership with a urgent care clinic, ocupational health clinic, or a primary care physican  is critical to get your employees back to work quickly.  Our insurer partners have a network of physicians in place to channel your employees to when an injury occurs.
9. Pharmacy – You will be provided with a pharmacy card to help with funding for medications.
10. It is critical to the success of your program to report claims immediately.  We refer to the time between the date of injury and the date the claim is reported as the “lag time.”  We monitor the “lag time” for clients.  There is a direct correlation between increased lag time and the cost of the claim.  (Increased lag time means increased costs – all else equal.)

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