PracticalTips and Tools For Effectively

Managing Worker’s Compensation Cases

Why manage work related injury cases?

• Emerging risks/trends– Co-Morbid conditions i.e. Smoking, Obesity, Diabetes– Narcotic usage– Diverse workforce– Psychosocial issues

• Have the program and procedures in place if a case goes to hearing

• Consistent program will promote feeling of fair treatment

Objective…

• Gain information and examine formats for use in case management of worker’s compensation cases

• Stimulate thought on improvement of current program and practices

Agenda

• Where to begin?• Documentation and

Communication• Work Related Injury Work Rules• Accident Investigations• Transitional Duty Programs• Worker’s Compensation Carriers• Medical Providers

Wearing multiple hats? Where to begin?

• Designate an “information clearinghouse” or two. This should be the person who is doing the case management. If that person is out who resumes responsibility? Be sure to communicate this contact information with your medical providers and insurance company.

• Develop a return to work program, including the requirement of immediate reporting of all injuries

• Ensure your work related injury program is enforced consistently and fairly.

• Communicate the program to all of your employees, – make a program that is collaborative not adversarial

Documentation and Communication

• Create a file for each employee when a work related injury occurs. This file should contain medical information including:– All aspects of activity on each work related injury– Copy of signed work rule– All information from treating providers related to

this injury– Do not include any violations of this injury’s work

rules in this file – this should be in the employee’s personnel file

Documentation and Communication cont’d

• Communicate to the injured employee your expectations for their role in their injury treatment and care (use the work rules)

• Ensure all of your supervisors or other designated “overseer” consistently enforce and document the rules

• Document all communications regarding this injury in the injury file

Documentation and Communication cont’d

An injury occurs, now what?

• Complete full accident report whether employee plans to seek treatment or not

• If employee seeks medical treatment, review and sign “company work rules” regarding workers compensation claims

• Review accident reports for rule violations, training needs and assign responsibility for completion

• Document all safety rule violations, observed and consequences of violation

Work Related Injury Work rules

• Employees should understand the work rules are expectations. Any violation will mean discipline, just like violation of any other work rule.

Work Rules (continued)

• Verbally review rules after completing accident report and get signature. Remind employees that if they violate these work rules, they will be disciplined for the violation not the injury

• Discuss objective with the injured employee, what are your plans and objectives to recover? Share with them that your objective is to return them to their regularly assigned job in a safe and timely manner.

• Provide copy of rules to employee

• Communicate to the employee that they are responsible to work within their restrictions and to assist you will be communicating the restrictions to all supervisors.

• Communicate to the employee what will happen if the restrictions are not followed.

• Documentation of a work rule violation belongs in the personnel file, not the medical file.

• Enforce rules consistently and document enforcement

Accident Investigations

• Evaluate usefulness of current accident investigation format

• Require completion of “in your own words” description for injured employee and witnesses

• Get signatures on all paperwork related to accident report

Accident Investigations

Accident Investigations

Accident investigations (continued)

• Get a picture of the scene

• Video the job

• Accident Review Committee

Transitional Duty Programs

• After receiving restrictions, make a formal modified duty job offer to employee

• Review employee obligations for attendance, quality of work, dress code, phone calls, etc.

Transitional Duty Programs

• Require regular communication from employee even if job offer not accepted

Transitional Duty Programs

• Prepare a bank of job possibilities for a variety of restrictions OR modify regular job

• Document physical requirements for jobs

• Track employee adherence to restrictions as necessary

Transitional Duty Programs

• Require documentation from medical provider at each appt and monitor changes in restrictions

Worker’s Compensation Carriers

• Develop working relationship with claims representatives handling your cases.

• Request aggressive claims handling. The squeaky wheel gets the grease.

• Inform claims representatives of your company return to work program and procedures

Worker’s Compensation Carriers

• Provide information to claims representatives as soon as possible – accident investigations, red flags, etc.

• What are the “red flags”? Multiple claims, multiple doctors, un-witnessed injuries, no shows for appointments

• Educate yourself by asking questions about why action is taken – or not taken by the claims representative

Worker’s Compensation Carriers

• Participate in decisions regarding use of case managers, IME’s, records review, surveillance

• You know more about your employees, local physicians, and your facility than the claim handler

• You are paying the bill!

Medical Providers

• Maintain communication with medical providers but do not expect the medical provider or his/her office to do your employee relation work

• Can’t get a hold of the doctor? Find out if there are internal worker injury case managers. If not, find the provider’s nurse, or receptionist to assist you.

• Maybe the phone is not the way to go. Try faxing your questions or clarifications. Does the office have email you could use?

Medical Providers

• Ensure the medical provider completes a thorough return to work form

• Discuss non-payment of bills with claim representative if not getting necessary documentation

• Do not except a loss time injury until you have contacted the provider. Ask the provider a direct question, “Couldn’t he help out here with inventory as long as we have one handed work available?”

Medical Providers

• Is there an occupational medicine provider on staff to assist in the treatment of your injured employee?

• Invite provider(s) to tour your facility to allow them to gain insight to the work environment and expectations

• Any questions?