Securing Great Outcomes in Workers’ Medical Care No Surprises! The Importance of Conveying & Gathering Expectations Welcome to my series, “Securing Great Outcomes in Workers Compensation” which will explore various techniques in effective claims management. In this first installment, I will explore the importance of conveying expectations to the injured worker relative to medical care. […]
Securing Great Outcomes in Workers’ Remedies Resources
No Surprises! The Importance of Conveying Expectations
Welcome to my series, “Securing Great Outcomes in Workers Compensation” which will explore various techniques in effective claims management.
In this installment, I will explore the importance of conveying expectations to the injured worker regarding remedies and resources.
Remedies and Resources
• Examiners are the Resource: The examiner must be a resource for the injured employee with transparency being critical in the process.
• Communication: Many administrators have the ability for the employee and examiner to communicate via text and email. Explain all methods of communication.
• Available Remedies: Almost every action taken by a claim administrator impacting the injured worker offers corresponding a remedy. Take the time to itemize possible challenges in the claim process and available “offramps.”
• Explaining Remedies: Taking the time to explain remedies can help ease the employees concerns and assure them of alternate avenues in the event they disagree with a determination made by their physician and/or examiner.
It is important to ask the employee what they expect in having various remedies or resources available. Do they feel isolated, alone, and helpless? This is a prime opportunity to tailor this discussion to their various concerns and ease anxiety.
This by no means is an exhaustive list, but instead topics I found helpful to build a solid foundation in effectively adjusting a workers’ compensation claim and securing a great outcome. I learned that putting the time and care early in the life of a claim paid high dividends and greatly assisted in resolving the matter timely and equitably.
We are here to help. Try Us First is powered by Alta Claims Services, Inc. Visit https://tryusfirst.com or info@tryusfirst.com today to learn more.
Securing Great Outcomes in Workers’ Resolution
No Surprises! The Importance of Conveying Expectations
Welcome to my series, “Securing Great Outcomes in Workers Compensation” which will explore various techniques in effective claims management.
In this installment, I will explore the importance of conveying expectations to the injured worker regarding claim resolution.
Resolution
• Start with the End in Mind: The expectation should always be for the employee to recover, and the claim closed.
• Duration for Recovery: Provide an anticipated duration for recovery.
• The Physician’s Role: Many of the benefit decisions made by the examiner are based on what is communicated by the employee’s physician.
• Maximum Medical Improvement: Explain what this means and the next steps when it occurs.
• Benefit Notices: Make sure the employee is not surprised by a denial of permanent impairment, so explain the various scenarios and resulting notices.
• Conclusion: Outline how a claim is concluded and the forms that will need to be completed.
• Potential State Board/Bureau Resolution Approval: Articulate the role of the State’s Workers’ Compensation Board/Bureau in this process. In many cases, the State’s Board is an additional advocate for the injured individual.
As noted in my prior bogs, it is always important to secure the injured worker’s expectations. Asking the employee’s expectations regarding resolution at the onset of the claim can help temper unrealistic expectations and lend to a conversation on the process and any resulting compensation.
We are here to help. Try Us First is powered by Alta Claims Services, Inc. Visit https://tryusfirst.com or contact us at info@tryusfirst.com today to learn more.
Securing Great Outcomes in Workers’ Lost Time
No Surprises! The Importance of Conveying Expectations
Welcome to my series, “Securing Great Outcomes in Workers Compensation” which will explore various techniques in effective claims management.
In this installment, I will explore the importance of conveying expectations to the injured worker regarding lost time benefits.
Temporary Disability
• Benefit Notices: Ensure the employee is aware that notices are mailed when benefits are initiated, changed, stopped, or resumed.
• Receiving Benefits: Inform the employee when they will receive their first check, the amount and schedule for future payments, if any.
• Benefit Caps: Understanding the cap on weekly amounts is especially important for high wage earners. In addition, for those seriously injured, explaining caps on duration can help avoid surprises later.
• Accommodation: Make sure they know the possibility of temporary accommodation of work restrictions by their employer.
• Return to Full Duties: From the onset of the claim, it should always be the expectation and goal that the employee recovers and returns to full duties.
• State Disability Benefits: If the claim is being questioned or benefits delayed, point the employee to other alternate benefits available to them such as State Disability.
As noted in my prior blogs, it is critically important to gather the employee’s expectations. Regarding lost time, make sure to ask the employee when they expect to return to work and what obstacles may impede them from doing so. This is a prime opportunity to problem solve and understand the potential duration of lost time.
This by no means is an exhaustive list, but instead topics I found helpful to build a solid foundation in effectively adjusting a workers’ compensation claim and securing a great outcome. I learned that putting the time and care early in the life of a claim paid high dividends and greatly assisted in resolving the matter timely and equitably.
We are here to help. Try Us First is powered by Alta Claims Services, Inc.
Visit https://tryusfirst.com or contact us at info@tryusfirst.com today to learn more.
