CLAIMS REPORTING AND HANDLING – Cost Reduction Guide

CLAIMS REPORTING AND HANDLING
Profit Sheet – Cost Reduction Guide

Costs involving employees whose claims are not reported immediately or mishandled can increase the cost by as many as 10 times or more. Be sure to handle claims correctly, every time.

Observation Solution
1. Not Reporting Claim on Time Educate Manager on proper procedure
2. Similar Injuries Occur Proper investigation conducted to find root cause of issue

REDUCING COST EXPOSURES:

  1. Reporting Claims on Time:
    1. Insure all managers are familiar with how claims are reported.
    2. Do not judge employee to be faking it, or not really hurt. Note concerns, but report the incident.
    3. Establish a goal that all injuries are reported within 24 hours. Ensure that approved doctors lists are kept up to date, so the manager and the employee know where to go immediately. Only send the injured employee to the emergency room if it is an actual emergency.
    4. When the claim is reported, in addition to medical treatment, the employee should be drug tested (consult state laws for restrictions).
  2. Educate Employees
    1. Contact the employee regularly when they are out of work. Show your concern. Ask questions, answer any questions they have. Start the Return to Work discussion.
    2. Take all reports of injury seriously.       Regardless of your opinion of an injury or circumstances, take down the information, and report to the insurance company so they can investigate. Report your concerns to the insurance company.
    3. Explain the employee’s rights under your State’s Worker’s Compensation Laws, and how benefits will be received. If you do not answer an employee’s questions, a lawyer will.
    4. Return to Work accommodation is required under the American’s with Disabilities Act. Failure to try to accommodate transitional duty job restrictions can result in a lawsuit.
  3. Analysis & Education
    1. Perform a root cause analysis on all injuries, and near miss incidents. Be sure to document any fraud indicators as well during the investigation (see free resources, below for information).
    2. Initiate corrective action on all causes of the incident.
    3. Share corrective action with all shifts, and all other stores and managers.
    4. Follow up to determine effectiveness of corrective action, and make additional changes where necessary.

FREE RESOURCES TO ASSIST IN REDUCING CLAIMS COSTS:

Claims Management Checklist

QUICK PRINT: Work Comp Claims Management

Accident Investigation – Stop Injuries Now

Preventing Fraud in the Workplace

Reporting Suspected Fraudulent Claims

FORM:  Accident Investigation

Worker’s Compensation – Fraud Warning Signs