Chapters

Workers’ compensation is required in all states (except TX), territories, and other developed nations for injuries and illnesses that occur in the course of employment. Under workers’ compensation:

• Injured employees are provided with guaranteed medical and wage loss benefits without proving the employer is at fault.
   
• Employees give up the right to sue the employer.

Companies pay for insurance according to the level of their risk. Premiums and deductibles usually increase when workers’ compensation is NOT handled efficiently.

Depending on company size and injury complexity there are many players involved in the workers’ compensation industry, such as:

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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

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There are specific Best Practice standards the primary injury management team can implement to meet and surpass national standards. Briefly these standards are:

Injury coordinators:

• Implement a proactive post-injury response procedure.
   
• Develop a communication program.
   
• Bring labor unions on-board.
   
• Adopt a corporate-wide transitional duty program.
   
• Teach workers’ compensation concepts to management highlighting cost savings.
   
• Know the key indicators of malingering, fraud, and abuse.

Supervisors:

• Provide injured workers with all necessary forms.
   
• Obtain appropriate medical help for the injured employee.
   
• Train subordinates on rights and responsibilities in workers’ compensation.
   
• Know about and complete all forms concerning the worker’s accident.

Middle managers:

• Know the roles and responsibilities of employees, supervisors, and providers.
   
• Track and report lost workdays monthly to management.

Risk managers:

• Ask: Does claim volume require dedicated staff to handle and implement claims?
   
• Attend association seminars to learn about other workers’ compensation solutions.

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A strong communication strategy is the key to a successful workers’ compensation management program. Both proactive and reactive communication is critical to saving money in a company’s workers’ compensation program by training employees before an injury occurs and reacting correctly after an injury occurs in the workplace.

Proactive communication is written/verbal communication the employer disseminates to employees about the company’s policies, programs, and procedures expected of them following a work-related injury.

Reactive communication is the post injury communication the company establishes and maintains with its injured workers so they remain psychologically connected during recuperation and focused on the final objective of returning to work as healthy, productive employees.

Workers’ compensation best practices include:

• Using a mission statement to outline the organization’s worker compensation policies and employee expectations.
   
• Outlining injured employee benefits and delivering those benefits on time.
   
• Using formal communication with injury response steps and written policies.
   
• Using informal communication such a “Get Well” card.
   
• And More

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Employers and risk managers need to know the services provided by their insurance company and/or their third-party administrator (TPA). If employers are not satisfied with the performance of the adjusters assigned to their account, they need to know how to correct the problem.

Cost Reduction Areas to Consider:

• Bundled services
  When the same insurance company provides the insurance and administers the claims.
   
• Unbundled services
  The insurance and claims adjusting functions are separate.
   
• Deductible affects control
  The higher the deductible, the more control the employer has over how claims are handled. Self-insured organizations have the most control over their claims.
   
• Communication and meeting with claim partners and handlers
  Best Practices require regular communication.
   
• Reviewing open claims regularly
  Discuss claims and transitional duty opportunities; assess employee return-to-work status; fine tune plans of action; check for fraud; and develop a time line for claim resolution.
   
• Account handling instructions address:
  

  Settlement authority Timing of status reports Subrogation waivers Recorded statements And More

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