Face your biggest challenge: How to successfully navigate workers' compensation claims


Taking a backseat during the claims management process can have a devastating effect on the outcome of workers’ compensation claims. The Insurance Information Institute (III) estimates that workers’ compensation medical costs could equal 70 percent of system costs by 2016. As claims severity escalates, claims management will become progressively more difficult and complex.


Ready, Set, Hire


According to the Bureau of Labor Statistics (BLS), the United States added 69,000 jobs in May, marking the 27th consecutive month of job growth. Finding new employees will be a growing concern for many employers, so when hiring, it’s critical that employers implement claims prevention tactics to avoid the hiring mistakes that can lead to injuries, claims and increased workers’ compensation costs. The recommended process is as follows:

  • Screen resume/applicant screening
  • Conduct thorough interviews
  • Perform background checks
  • Establish effective post-offer drug and alcohol testing
  • Exercise conditional offers of employment, based on the candidate being physically able to perform substantially all of the essential job duties of the position
  • Provide post-offer pre-employment exams before the start of a job


Make Employees Accountable


Even with the best hiring practices and the strongest safety culture, some claims will still occur, but there are effective ways to manage claims once filed. Return to work (RTW) programs offer an effective strategy for an employer to control claim costs, with advantages for both employers and employees.

RTW programs reduce workers’ compensation costs, deter system abusers, avoid the need to train replacements and provide work productivity during the medical recovery period. Through RTW programs, employers demonstrate the importance of employees to their organizations. Employees feel a sense of self-worth, avoid an interruption of salary and benefits and are likely to recover more quickly and not become treatment dependent.


Establish A RTW Team


A clear step-by-step process can minimize the chance of re-injury and enhance the recovery process through productive, modified work. Employers must begin this process by naming someone who is responsible for each action item in the claims process. This establishes personal accountability and allows organizations to openly identify claims management gaps. In the RTW program, duties should be designated to the following employees:

Program Coordinator—The program coordinator facilitates the injured employee’s transition back to work and works with the injured employee’s physician to develop temporary modified work duties during the recovery period. This ensures productivity for the employee until full release.
Supervisor—The employee’s supervisor is involved with the documentation process, investigation and future prevention of work-related injuries. In addition, the supervisor is responsible for reaching out to the injured employee through regular phone calls, get-well cards and flower arrangements, occasional visits and employee invitations to work-related functions.
Employer Communicator—A member of the company should be designated as the employer communicator throughout the claims process. The communicator is responsible for maintaining contact with all parties involved throughout the injury, including the employee and his or her family, employer, internal personnel, the broker, the insurance adjuster and the employee’s physician and therapy facilities.

Develop Transitional Job Descriptions



During the hiring process, a detailed description of each position’s essential tasks and responsibilities will curtail future claims. This description should include specific credentials or skills necessary to perform the job, such as heavy lifting.

Employers should identify temporary transitional positions and create detailed descriptions before a claim is made. Transitional work allows employees to perform meaningful work and continue as productive members of an organization until they have the necessary capacity to perform normal job duties. To ensure the RTW program’s implementation, employers should include employees of all levels in identifying potential transitional duties.


Create a Panel of Experts


Insurance brokers can establish a panel of physicians and medical professionals committed to preventing fraud and abuse. Teaming up with the right doctors can save money for employers and a well-screened panel of physicians demonstrates a commitment to employee health.


Physicians should be viewed as an extension of the risk management team. Visiting the work site can give physicians a clear picture of the duties a worker performs for the organization and the types of transitional positions available. Doctors will only be able to recommend the right transitional job and to specify more accurate absence durations if they know what is physically required to do the job.


Require Open Communication


During a claim, open communication among the injured worker, employer, medical provider and insurance carrier is essential to ensuring the most successful resolution for all parties involved. An employer should instruct the physician for a claim to follow up immediately on appointments, like sharing of medical notes between the employer and claims adjuster. This ensures that employers are alerted to any red flags—for example, if the physician suspects the injury was not work-related. Employees should also be required to check in following any medical visits or treatment.