Warning: If You Don’t Communicate You Litigate
It is absolutely essential that your claim management team communicate with the injured employee, healthcare providers, claim adjusters, and attorneys early and often throughout the claim process. Otherwise their “systems” will control them. This communication should be provided both in verbal and written form and well documented. And, because this communication will be performed by many members of the claim management team, it is essential that the team members communicate effectively with each other as well.
Here are proven communication techniques that work effectively:
- Formalize and communicate your claim management policy. The organization must develop and communicate claim management procedures and policy. This manual will provide information and sample policy templates in a number of key areas. Claim management policy establishes the ground rules for everyone in the organization to follow in the event an employee is hurt on the job. These policies must be fully understood by all members of the claim management team so that infractions are accurately identified and proper action is taken in accordance with organizational policy.
- Explain the claim process to the injured employee. Successful organizations are proactively communicating with their injured workers throughout the claim management process. This starts the very first day the employee is injured and includes an explanation of what they can expect from the claim process, how their medical bills are going to be paid, and who they can contact for questions.
- Establish claim procedures with the claim adjuster. It is critical that the claim management team have a formal and detailed meeting with the claim adjuster(s) who will handle the organization’s workers compensation claims. At this meeting the claim management team should review communication procedures with insurance company adjusters so that everyone is on the same page. It is also important to review the organization’s entire claim management process with the claim adjuster and discuss how the organization expects them to communicate with members of the claim management team as they adjudicate each type of claim. In this regard, it is important that the claim management team work with the insurance company to write “Claim Service Directives” that are consistent with mutual expectations.
- Establish prompt response procedures with the treating physician. The first 48-hours after a worker injury are critical and the healthcare facility has a vital role in it. It is recommended that the organization’s Prompt Injury Response Program be discussed in detail with the treating physician so that everyone is on the same page. If the claim management team senses that the healthcare provider wants total control over the claim process this should be a sign of future problems. It is also recommended that the claim management team discuss the fact that the organization offers a Temporary Duty Program in full compliance with state and federal laws and that it expects all medical providers to fully support the organization in its effort to identify and assign these temporary tasks where medically permissible.
- Always have on-going communication with the injured employee. The claim management team must stay in constant contact with the injured employee from the date of injury until they are released to come back to work. The injured employee must communicate with the Claim Coordinator at least on a weekly basis and the Supervisor must be in periodic contact with the injured employee as well.
These techniques will significantly reduce both the direct and indirect workers compensation costs, improve your overall workers compensation claim management program, and improve workers compensation disability management.
The Resource Library within the CompEraser system is loaded with all the tools, forms and checklists you must have to successfully communicate with your injured employees. For more information go to www.comperaser.com.
