Early Intervention will save your firm many of the costs associated with workers compensation claims that “fall through the cracks.” Early intervention on all new claims has proven to have a positive impact on length of disability and ultimately, claim pay out. A pro active course of action preserves investigative facts that can affect compensability and/or offset opportunities. Early intervention also enhances our ability to provide appropriate medical management.
Checklist for Handling Claims
The initial period is defined by C & I Safety as the
first four days of any claim. The initial period is critical in handling
workers’ compensation claims. This is not an exclusive or inclusive list. Be
sure to:
Immediately
Obtain first aid or medical services
Have someone
accompany injured worker to a selected medical provider (preferable but
employee has final choice)
Report incident/ accident within
Notify family if
applicable
Assign a responsible person to follow the claim
Document the area’s
condition
First day (Responsible person to follow claim)
Report to claim handler
outside company (insurance company or third-party administrator)
File
a State of WI
First Report of Injury (WKC12)
Obtain initial Medical Report
and Duty Status Report
Determine, on a preliminary
basis, whether the injury is covered by workers’ compensation
Refer case to insurance company or third-party administrator for investigation
Determine type of claim - Medical Only - Restricted or Transfer - Lost Work Days or Days Away from Work
Review supervisor’s report for initial determination in regard to the necessity of an investigation
Follow up with the employee
First
four days (Responsible person to follow claim)
Talk
to insurance company or third-party administrator
Talk
to treating physician about Medical Report and Duty Status Report if applicable
Talk
to treating physician to learn diagnosis and treatment plan
Evaluate
whether medical rehabilitation is necessary or appropriate
Develop
return-to-work plan
Forward
all correspondence to insurance company or third-party administrator
Follow
up with the employee
Responsible
person to follow claim
Ongoing (Responsible person to follow claim)
Talk to insurance company or third-party administrator
Talk to treating physician about Medical Report and Duty Status Report if applicable
Forward all correspondence to insurance company or third-party administrator
Follow up with the employee
Continually reevaluate treatment plan based on new medical information
Update return-to-work plan
Refer for vocational rehabilitation
Refer for pain management evaluation of chronic pain, if appropriate
Maintain contact with the injured employee
Use a “wellness” approach to continue to reinforce company’s concern
Consider medical examination by independent physician (IME), if warranted