BPM
Transcript: Presented By: Wayne Clark Claims Management is Cost Management When an injury occurs. When an injury occurs. Non Life threatening conditions: Call Medcor at 800-775-5866 24 hours a day, 7 days a week The supervisor and injured employee should place the call together. Potentially life threatening conditions: CALL 911 Potentially life threatening conditions: CALL 911 Does not seek medical treatment. Complete a report on all incidents and keep in the employee’s file. Retain all incidents reports and “near misses” for use in identifying trends and areas needing training. Incident only? Incident only? Incident Report Medical attention is sought from a physician, hospital or clinic. An employee requests to file a claim. A physician or Church Mutual notifies you an employee sought treatment. A supervisor or manager witnesses an incident they believe will result in a claim. When do I file a claim? When do I file a claim? Communicate any concerns immeditely to the claims examiner. Red flags may include: Red Flags Did not report or a delay in reporting injury. Questionable mechanism of injury. Unwitnessed injury. Disgruntled or poor performing empoyee. New hire and/or unstable work history. Hesitant to communicate facts of injury/claim. Immediately retains an attorney. Red Flags The Cost of Claims Unseen costs can sink the ship! On the average, indirect costs exceed direct costs by a 4:1 ratio. Direct and Indirect Costs What Can I do? Claims Management Medical Treatment Managing Medical Treatment Select a clinic that: Treats injured employees promptly and respectfully Addresses work restrictions Is aware and mindful of your return to work program Develop a relationship with the local medical clinic and community. Providing light duty work is the most effective way to control claims costs and have a positive impact on premiums. Transitional Light Duty Work Case Study: Back Surgery Case Study: Back Surgery No RTW With RTW $18,000 Timeloss $5,100 $35,000 Medicals $25,000 $45,000 PPD $15,000 $60,000 VOC $0 $158,000 Total $45,100 Productive work. Intended to be temporary. Faster recovery with early return to work. Reduces medical costs. Less likely to retain an attorney. Assists with avoiding focus on injury and perceived disability. Reduces incentive to file claims just to avoid work. Light Duty Light Duty Levels form Levels form BJO BJO Time is of the Essence Time is of the Essence Communicate, Communicate, Communicate! Keys to Success Consistent and ongoing communication is vital. Set expectations early on explaining the process and intentions to transition from light duty back to full. This is not an adversarial legal battle. Lack of communication or perceived lack of sympathy drives employees to attorneys. Prevents feelings of abandonment or alienation and keeps you informed of their recovery. Injured Employee Injured Employee Communicate early and often. If you have concerns about claim, tell the examiner. If an employee is put on light duty or released to regular work, tell the examiner ASAP. Keep information factual, not emotional when communicating with examiner. Don't assum the examiner knows what you know. Claims Examiner Claims Examiner
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