The hours and days immediately following an injury can set the course for the outcome of the claim. When the employer takes control many of the problems that occur in the system can be avoided. It is a one-time opportunity for the employer to set the tone, foster trust with the employee, and move toward an expeditious return to work for the worker.
Yet many claims are derailed in the days following an injury because of the following five mistakes:
1) Delayed reporting
Numerous studies have confirmed that the longer the lag time in reporting injuries, the higher the cost of the claim and the higher the probability of litigation. A study by Firemen’s Fund reported a three-day delay adds 16 percent to medical costs, 38 percent to indemnity cost and increases attorney involvement by 50%.
A best practice is to report all injuries the day they occur and the report should go to the carrier within 24 hours of injury notice. This requires training employees to report all injuries promptly and educating supervisors on the importance of timely reporting and including this as part of a performance evaluation. Employers who have “zero accident” goals or similar programs, need to be sure that the system does not discourage reporting so that minor injuries do not morph into major claims.
In addition to lowering costs, prompt reporting ensures a more accurate accounting of the incident, the elimination of a potential hazard to others, an increased opportunity for a modified return to work, immediate medical intervention and establishing a medical treatment plan.
2) Lack of involvement with the treating physician
While state statutes differ with respect to the extent employers can direct injured workers to qualified medical providers, the proper medical care from the outset is critical for both the employee’s well being and cost control. A 2010 Johns Hopkins study concluded that the practice patterns of physicians participating in a Workers’ Compensation system had a profound impact on the ultimate cost of claims. Moreover a recent study by California Workers’ Compensation Institute (CWCI) found that 10% of doctors prescribing Schedule II opioids for injured California workers accounted for nearly 80% of all Workers’ Comp prescriptions for the drugs and 88% of the associated payments.
The treating physician is at the center of virtually every significant aspect of Workers’ Comp claims, including deciding which medical treatments to use, whether an injured worker should lose time from work and if/when they are ready to return to work. To control risks employers should:
- Avoid treatments at emergency rooms, which can increase initial costs 4 or 5 times. Having a clearly defined process for medical evaluations, treatment and care when an injury occurs is critical to controlling costs.
- If the treating physician is unknown, investigate to be sure he/she is not part of the small percentage that prescribe narcotics freely.
- Immediately inform the physician of modified work options available for the injured employee. Begin the dialog with the physician and employee early so that it is clear the goal is to return the employee to work as soon as medically possible.
- If the treatment does not seem appropriate for the injury, address the issue immediately before it spins out of control.
3) Inadequate information about co-morbidity issues
Despite the growing evidence that co-morbidity issues such as obesity, diabetes, high blood pressure and smoking exacerbate claim costs and injury durations, many claims adjusters do not explore them during the initial intake process. The first indication that a claimant is obese may not come until the doctor’s first report, which may be several weeks into the claims process. The claims management and medical treatment for an obese person may differ and should be addressed early on in the process, so employers should communicate as much as they know to the adjuster.
Also, if you know or suspect there were previous claims, encourage the adjuster to send out a request for a signed medical release. This can help prevent delays in obtaining prior medical records.
4) Fail to build trust with employee
For many injured employees, this is the first time they have encountered the Workers’ Comp system and their initial reaction may be fear and uncertainty. The immediate response by the employer sets the tone. If the employer acts indifferently, the employee’s attitude will quickly transcend to mistrust. On the other hand, if the employer’s response conveys support and interest in the employee’s wellbeing, the employee will feel valued and motivated to return to work.
While this emotional aspect plays a key role in the recovery it is often overlooked and there is little communication with the injured employee. Michael Shor, Managing Director of Best Doctors® Occupational Health Institute notes: “The ability of a treatment, drug or intervention to help an injured worker is directly related to the injured worker’s belief that the clinician, claims examiner or employer wants to help him/her. What is actually done is far less important than the intention with which the injured worker believes it is done.”
5) A feeble return to work program
While the implementation of a return to work (RTW) program is often cited as a best practice for employers, it is important to recognize that only well-constructed and administered programs will succeed. Merely having a policy or occasionally making an offer is not enough.
RTW assignments are best described as transitional tasks. Limited in duration, such tasks help the injured worker return to full productivity by being progressively adjusted in line with medically documented changes in the employee’s ability. Serious employers draft functional job descriptions to provide the doctor with detailed information about the physical requirements of each position.
While returning injured employees to work after a week or two can take the financial sting out of a claim, offers to return to transitional work have the biggest potential for cost savings when they prevent a medical-only claim from becoming a lost time claim. This sort of offer requires timely medical information. Receiving immediate medical reports can only happen if there is close communication with the injured employee and cooperation from the medical provider.
The Seltzer Group, located in Eastern Pennsylvania, specializes in developing safety, workers compensation, human resources, claims, and risk financing programs. They are a proud member of the Keystone Insurers Group and are nationally recognized for their expertise in workers compensation solutions. The Seltzer Group serves businesses and individuals locally, regionally, and on the national level.
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