Do you know how to manage works comp claims?

Managing workers' compensation claims is straightforward when a specific incident results in an injury (or aggravation of a pre-existing condition) that is not questionable. It's much more difficult when the claim: 

  • did not have a specific incident,
  • started with a questionable event, or
  • happen right before someone is about to get terminated for poor performance.

There are several steps you can take to minimize the frustration. If your state allows "directed care" you can post an approved list of doctors, and if the list is compliant (check state requirements), employees have to choose a treating physician from the list. This prevents the employee from using the doctor the lawyer recommends because the doctor and the lawyer are working together to extend the claim for additional profit. Yes, that happens. 

Suppose the injured employee says it happened on Friday afternoon when no one was around but reported it Monday morning. In that case, you can report it to your insurance company as a hot claim, meaning it deserves extra attention up front. It's not an accusation. It's just an alert to ask a few more questions. If it's highly suspicious, you could request a recorded statement, even in person, if your insurer will do that. 

If the claim is dragging on and on with no return to work in sight, or if the claim is a back or neck injury, request a nurse case manager to monitor the treatment plan and move it forward. 

In Georgia, a claim may be denied if the employee fails a drug test within hours of the incident. Little known fact: a claim may also be denied if the employee falsified his employment application. 

If an employee actually gets hurt on the job, take care of them, work with them, and help them return to work and continue to support their families. But, if it's a nonsense attempt to take advantage of the system, take the steps above to reduce the damage. 

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