By
Kara Lindstrom, Director of Claims

Management of workers’ compensation claims is true passion of yours, right? All claims end with the exact outcome you wanted, right? Now that you are either rolling your eyes or laughing, let’s talk through a few things that will help you succeed in achieving your desired outcomes on your workers’ compensation claims and program.

While many hear workers’ compensation and want to run as fast as they can in the other direction, management of workers’ compensation claims is an incredibly important topic. The more focus you have on these claims, the better outcomes and results you’ll have for your company.

Workers’ Compensation Claims Pre-Work

Even before a claim happens, the people and processes you have in place drive these outcomes. A few things to consider:

  • Do you have staffing issues that are impacting your claims’ outcomes?
  • Does leadership support your risk management goals?
  • Are your training programs sufficient?
  • Have you established a relationship with a strong, occupationally focused medical provider?
  • Do you have a streamlined process in place to report and manage your workers’ compensation claims?
  • Do you have a strong crisis response plan in place?

Reporting Claims in a Timely Manner

Once a workers’ compensation claim actually takes place, the claim should be reported timely. Studies have shown increased costs associated with delays in claim reporting.

In fact, according to a 2021 Liberty Mutual study, claims reported after 29 days were 33 percent more likely to become an indemnity claim than those reported in 0 to 3 days. In addition, they found a correlation with the percentage of increased costs associated with the number of days delayed in reporting:

  • 4-7 days: 9 percent
  • 8 – 14: 21 percent
  • 15-21 days: 33 percent
  • 29+ days: 52 percent

The National Council on Compensation Insurance (NCCI) revealed in a 2015 study that less than 13 percent of claimants had attorney involvement for those early reported claims versus 32 percent of workers who sought legal representation for those claims reported more than four weeks after they occurred. Attorney involvement can boost the claim costs by 12 to 15 percent.

Communication Is Key During the Claim Process

Throughout the claim process, communication remains the key factor to a desired outcome. Communication between injured workers, their managers, and the claims team is critical. Having a strong relationship with your claim adjuster and helping them understand your business will have a direct impact on the outcome of a claim. Additionally, managers should keep their injured workers engaged with the workplace, so they feel part of the team and want to come back to work.

Another factor to keep in mind is that all communication needs to focus on the injured employee’s abilities versus their disability. What CAN the employee do? What type of work is available? Do we need to consider an alternative light duty return to work plan? Do we have the right medical treatment plan in place? Do we need assistance from an onsite medical case manager? All parties should be focused on the exact same goal and understand what the strategy is to achieve that goal.

Tools to Help with Workers’ Compensation Claims

Beyond the day-to-day communication and management of a claim, there are many tools that can be used to identify areas of opportunity to achieve better outcomes. I’ve noted a few of these opportunities below:

Claim Reviews

You should review claims both with your carrier and internally to focus on the actual strategies to move your claims toward resolution. Also consider regular reviews with your agent/broker to discuss what is working or not working with the claim process.

Frequency and Severity Focus

Ensure sure you understand where your claims are coming from or what they are a result of. The goal is to try and prevent injuries with focus on better ergonomics and/or planning. Areas to focus on:

  • Physical Location of incident
  • Type of injury (i.e., sprain, strain, laceration, etc.)
  • Mechanism of injury
  • Body part involved

Focus on Key Financial Metrics

Focus on the metrics that are most impactful to your workers’ compensation program (for example: total case reserves, open loss time claims, and/or costs associated with a certain location, type of injury, etc.) Do your leaders understand the impact these claims have on your organization? Review this data monthly as you may find results directly related to a process that needs to be updated or adapted.

Engage Your Peers

Your peers can be of tremendous value to you. Learning from others and their experiences can be invaluable.

Work with Advocates

Last but not least, work with us! As your advocates, we are happy to help you out with all of this! Our Risk & Safety team can help with pre-injury planning. Our claim team can help bridge the communication gap, ensure strong claim strategies are in place, participate in claim reviews/audits, and work through any type of trending and metrics that you may need to better understand how to achieve desired outcomes.

We are here to partner with you; let’s get started!