The following article was written by Stuart Baron, Esq. of Stuart Baron & Associates. Stu and I have been working together for a number of years now to tackle workers claims management. I asked him to write down a few thoughts so here they are!
An Aggressive Approach to Workers Comp Claims Management
There is no question that a good and, where necessary, an in-depth medical diagnosis is critical to the success or failure of any workers’ compensation claim. For most claims, a well-trained occupational doctor will be able to provide a comprehensive medical evaluation of the injury. This will be an examination that properly documents the facts surrounding the injury coupled with a viable treatment plan that focuses getting the injured employee back on the job. I would estimate this scenario will be true in at least 80% of the claims filed.
But then we have those claims that do not pass the “smell test.” You have all seen them. They are the “I fell down on the back part of the plant and no one saw it happen” claims. “And now my back (or insert whatever body parts you wish) hurts and it is all work related.” These usually happen about 15 minutes to an hour after their shift starts. It also happens right after the employee has received a bad performance review and has been written up for a safety violation.
Then we have the ever-popular Post Termination claim. These normally occur a week or later after the employee has left your employ either voluntarily or having been fired for cause. These claims usually come to you in the form of a letter from an attorney letting you know that your former employee suffered an injury and it is all your fault. This even where you have had an exit interview that specifically asks if they have any work-related illness or injury that has not been reported to you. The problem today is that we can defeat these claims–but at what cost? We are all seeing far too many claims settled for “nuisance” value in order to cut the carriers losses regardless of how defensible the claim is.
And finally, to add further insult to the claimed injury, we have the now rampant Cumulative Trauma or “I am wearing out” disease. The problem here is that it hard to defend when there is no real meat to the claim. The claim is usually “I hurt” but without being able to articulate what hurts and where. Doctors have been prone to opine that there are, of course, medical findings and therefore it is most obviously work related. We all know how the story goes from there. Very little has been done in the past to counter this type of claim. It is like trying to grab hold of a large balloon filled with water. You simply cannot get a good grip on it.
Well, all that has changed. US Healthworks has designed a next generation comprehensive and proactive approach to these claims. It is called Coordinated Care Management (CCM) and is designed to provide a real-time, comprehensive medical evaluation and active follow up of these claims. It encompasses a detailed medical history, a through medical evaluation of the claimed body parts, and a discussion of the causation of the alleged injury(s). Is it really a viable compensable injury or is the employee just getting older and wearing out like the rest of us? CCM, coupled with our FASTRAXX claims handling protocol, is enabling us to level the playing field and win more than we are losing.
WE INVITE YOU TO JOIN US ON MARCH 29 FOR A WEBINAR DESCRIBING THIS NEW AGGRESSIVE APPROACH TO CLAIMS MANAGEMENT.
You need only e-mail me at firstname.lastname@example.org, and I will be sure to forward you the registration form information. Please see the flyer on the back side of this month’s Hotline for more details….