Chapter 2 Summary – Fundamentals of Cost Containment

There are two reasons workers comp costs are high:

1. Too many claims lasting too long.
2. Employers fail to “take charge” of the process.

 

When employers fail to take charge,
the EMPLOYEES are in charge by default.

 

The adjuster is primarily responsible for administering claims. The employer is primarily responsible for managing the claim process within the work environment.

To remain out of work, an injured employee must substantiate an injury by providing appropriate medical documentation. In the documentation, the employer needs enough information about the injury to return the employee to work or find a transitional duty task.

The low-quality sample disability note (opposite) is a replica of a doctor’s certificate provided by an injured employee to the employer for a claim approved by the insurance company for a $100,000 settlement. This certificate does not contain any information useful to the employer such as a diagnosis, prognosis, estimated return-to-work date, treatment, or even the doctor’s phone number.

A useful work ability form must contain the following information:

• Employee name and contact
• Medical provider contact
• Injury type
• Diagnosis / prognosis
• Treatment plan
• Work ability at home and at work
• Next appointment
• Estimated return-to-work date
• Restrictions for a transitional duty job

For more information about this chapter, see the Table of Contents

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