Claims Management: Best Claims Management: Best Practices in Preventing Practices in Preventing

Mismanagement and Proactive Mismanagement and Proactive Approaches to Control Rising Approaches to Control Rising

Medical CostsMedical Costs

Nance L. SchickNance L. SchickDefense CounselDefense Counsel

New York, NYNew York, NY

Tiffany M. Holland, AICTiffany M. Holland, AICGallagher Bassett Inc.Gallagher Bassett Inc.Mechanicsburg, PAMechanicsburg, PA

Medical expenses Medical expenses often comprise as often comprise as much as 50% of the much as 50% of the cost of a workers’ cost of a workers’ compensation claim.compensation claim.

Advances in medical technology, Advances in medical technology, internet medical resources, the internet medical resources, the media, and advertising have media, and advertising have transformed the way we treat and transformed the way we treat and test claimants.test claimants.

A small percentage A small percentage

of claimants, attorneys of claimants, attorneys and physicians will and physicians will abuse the system abuse the system enough to increase the enough to increase the average claim cost average claim cost beyond reasonable beyond reasonable limits.limits.

You will rarely achieve You will rarely achieve disallowance of a claim.disallowance of a claim.

You “win” cases by You “win” cases by producing competent producing competent

medical evidence.medical evidence.

Thorough Thorough investigation investigation

is key to your is key to your success in success in

every claim. every claim.

Injury PreventionInjury Prevention

Maintain RelationshipsMaintain Relationships

Involve your employees Involve your employees in developing safety in developing safety

procedures.procedures.

Ensure they are trained Ensure they are trained on safe work practices.on safe work practices.

Know themKnow them

RetrainRetrainemployeesemployeesregularlyregularly

Immediate correction Immediate correction and communicationand communication

New New proceduresprocedures

Annual reviewsAnnual reviews

Employee Employee Assistance Assistance ProgramsPrograms

Human Human ResourcesResources

Initial InvestigationsInitial Investigations

PhotographPhotographthe scenethe scene Get witnessGet witness

statementsstatements

Locate Locate contracts & contracts & manuals for manuals for the property the property or deviceor device

ReportReportPromptlyPromptly

Follow your Follow your company’s company’s reporting reporting proceduresprocedures

Complete Complete WCB WCB Forms Forms C-2, C-11 C-2, C-11 & C-240& C-240

Ask the claimant to complete Form C-3*Ask the claimant to complete Form C-3*

Share What You KnowShare What You Know

Return to WorkReturn to Work

Maintain contact Maintain contact during disabilityduring disability

Schedule a weekly callSchedule a weekly call

Reinforce the claimant’s Reinforce the claimant’s value to the workplacevalue to the workplace

““Get well. We’ll see Get well. We’ll see you soon.”you soon.”

CommunicateCommunicate

Report promptlyReport promptly

SuspicionsSuspicions

Return to workReturn to work

Your participation in the investigation Your participation in the investigation and administration of your workers’ and administration of your workers’ compensation claims is imperative.compensation claims is imperative.

Employers underestimate their value in Employers underestimate their value in resolving their injured workers’ claimsresolving their injured workers’ claims.

Get involved.Get involved.

Improve relationshipsImprove relationships

Lower costs.Lower costs.