Workers’ Compensation Areas of Assessment

While you might think of Workers' Comp as a legal problem, it is really more of a management issue.

  • Even though the laws form the basis of the entitlement, it is a failure of processes which allow employees to remain out of work for long periods of time.
  • Our assessment will show your strengths and weaknesses.
  • From there you can build stronger links and begin to save money right away

Assess Your Workers' Comp Program

These are the 10 areas of assessment you should be looking at to control your Workers' Comp costs:

Performance Goals: Measuring your success against national benchmarks and your own performance indicates success and allows you to reward those responsible.

  • Use data as well as procedural goals. Gathering correct and useful claims data is the basis for developing performance goals
  • Procedural goals must be set so claim offices handle your claims effectively and meet your return to work targets
  • Locations needing improvement are given additional assistance

Post Injury Response Procedures: Procedures must be tight during the 24 hours immediately following an injury so injured employees return to work as soon as medically able.

  • Supervisors must know exactly what to do when an injury occurs
  • While there are many roadblocks to rapid return to work, most can be overcome if they are anticipated in advance
  • Have proper procedures in place from the moment an injury occurs until an employee returns to work on full duty, transitional duty, or both
  • Have procedures in place; it sends the message that you – the employer – are in control.

Communication: Development of consistent procedures includes having easy-to-read and easy-to-use forms and letters to gather information.

  • Convey your company's message through brochures, wallet cards and thoughtful gestures

    This ensures employees get YOUR message – not the attorney's who advertises on television

  • Documentation is based on the role each person plays
  • Communications with senior management, general managers, supervisors and employees is based on the intended use, reading level of users, language preferences and readability of your materials

Return to Work Programs & Transitional Duty: Once an employee is injured on the job, returning to work as soon as medically able becomes a primary focus.

  • An injured employee must be given the option of returning in a temporary transitional duty position, perhaps less strenuous than the original job, while recuperating
  • Learn what forms and letters to use to estimate appropriate disability durations and make job offers

Management Commitment: Upper management support of changes necessary to reduce workers' compensation costs is imperative.

  • Learn how to build management commitment and build an Improvement Plan to bring managers on board
  • Chargebacks and allocation systems motivate all levels of the company to comply with a workers' compensation control process by using the "carrot and stick" approach:
    • What organizational resources are made available to tackle the workers' compensation problem?
    • Does the company manage and monitor claims internally?
    • What role does each department play in the post injury and return to work process?
    • Are the people responsible for claims management knowledgeable about innovative risk management and workers' compensation cost containment techniques?

Insurance Co & Claims Administrator Performance: The insurance arrangement and claims system must be structured to support your company's processes.

  • Build a solid team approach to workers' compensation improvement
  • Your process is built around the services provided by vendors such as:
    • Medical clinics
    • Medical providers
    • Nurse case managers
    • Independent medical examination physicians
    • Investigation firms
    • Recovery firms
    • Structured settlement firms
    • Defense attorneys
    • Other services working to help you mitigate the cost of your claims

    How much do you know about these services?

Medical Care Coordination: Medical care must be coordinated so injured employees receive prompt, quality care by a physician or clinic which supports your company's goal of rapid healing and return to productivity.

  • It's important to know how medical care is selected in your state and select the best qualified physicians and clinics to gain maximum control of the medical care your employees receive
  • Include a medical advisor on your team to review medical care and effectiveness of medical vendors proactively within the first few weeks of disability – not after the claim has reached a $25,000 threshold.
  • Medical (RN or MD) Triage

Medical Cost Containment: We don't focus on reducing the cost of each medical visit, rather, we strive for overall cost reduction, which sometimes means paying MORE for a doctor who will spend more time with your injured employees.

It's very important to know the cost containment services which your TPA and insurance company use so you can control how often they are used and how much you will pay for services such as:

  • Medical bill review
  • Hospital bill review
  • Utilization review
  • Nurse case management (both telephonic and field-based)
  • Negotiated preferred provider networks and vocational rehabilitation

Fraud, Abuse and Malingering: Some people take advantage of the system by staging accidents, faking injuries or pretending they are injured more seriously than they are.

  • Be able to spot the red flags of fraud
  • Guide the investigators on your team
  • Read and review surveillance reports, videotapes and photographs
  • Learn how to coordinate investigation results with medical advisors
  • Have an anti-fraud program which includes a toll-free tip line

Training Initiatives: All levels in the company must understand their role and the exact steps needed to make their workers' compensation program successful.

  • As new processes are put in place, each level of the company must know how to use the new tools and must be able to explain the new policies
  • This new knowledge comes from training and education

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More