Injury Management Tool Kit ^TM

Recommendations for Improvement

Insurance Company and Claims Administration

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1. What is the most important factor in selecting a claims administrator?

   Your Answer: Excellent Customer Service

   Recommendation: Excellent quality claims handling and responsive customer service are necessary to reduce the cost of your claims. Focus on the cost-effectiveness of the TPA proposal, instead of cost. Short term costs may be lower, but don’t compromise long term cost reduction by making low cost your primary goal. Sometimes it’s better to pay more now in order to reduce cost long term.

   To learn more about implementing this recommendation, click here or here.

Communication
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2. After an injury, when an employee misses work, is he/she sent a get well card?

   Your Answer: No

   Recommendation: Part of your communication should be a personal get-well card sent to injured employees. This sends the message that you and the employee’s co-workers care about the employee and want him or her to come back soon.

   To learn more about implementing this recommendation, click here or here.
3. Are your company’s policies, documents, brochures and other communication pieces written at a 6th grade reading level?

   Your Answer: Don’t know

   Recommendation: In order for the communication strategy to effectively convey information, make all written policies, procedures and documents understandable to those who read them. If your employees are college graduates, communications can be at 12th grade level (like the Wall Street Journal). If your employees are not college graduates, write materials at 6th grade level (like the Reader’s Digest). Make sure to prepare translations if employees speak another language.

   To learn more about implementing this recommendation, click here or here.

Return to Work and Transitional Duty
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4. What percentage of employees return to work within the first 4 days after an accident?

   Your Answer: 70-89%

   Recommendation: It is important that your return to work program is EFFECTIVE. A good goal is 90-95% Return to Work Ratio – this means that 95% of injured employees who would normally lose time from work return to work within the first four days after an injury. This is an achievable goal which will bring down your costs dramatically.

   To learn more about implementing this recommendation, click here or here.
5. Is participation in the return to work program a condition of employment?

   Your Answer: No

   Recommendation: Participation in the transitional duty program should be a condition of employment – it’s not optional.

   To learn more about implementing this recommendation, click here or here.
6. Do all employees sign an acknowledgement of receipt of this policy?

   Your Answer: No

   Recommendation: It is important that your employees understand their responsibilities and that they acknowledge in writing that they have been given, have read and understand the policy.

   To learn more about implementing this recommendation, click here or here.
7. If employee’s have health insurance, does the company pay an additional portion of the premium if an injured employee is out of work or on transitional duty?

   Your Answer: Yes

   Recommendation: When companies pay an additional portion of an employee’s health insurance premium when an employee is out of work or on transitional duty, they often find that this added benefit makes it more lucrative for an employee to be out of work than at work.

   To learn more about implementing this recommendation, click here or here.

Medical Cost Containment
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8. For employers in CA: Are you a member of an MPN (Medical Provider Network) approved by the state?

   Your Answer: No

   Recommendation: One of the most useful methods of controlling a claim in California is to enroll in an MPN. This allows you to direct medical care for the life of the claim – and keeps your employees from treating with "doctor mills" which are known to keep employees out of work longer than necessary.

   To learn more about implementing this recommendation, click here or here.

Fraud, Abuse and Malingering
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9. Is there a toll-free number employees can call to report workers’ compensation fraud or abuse?

   Your Answer: No

   Recommendation: One effective way to reduce workers’ compensation fraud and abuse is to use an anonymous “tip line.” Many TPAs are affiliated with tip lines, so make sure to learn more about this useful tool. Use the posters provided by the carrier; post around the workplace. Ask the carrier for a periodic report of how many tips have been received.

   To learn more about implementing this recommendation, click here or here.

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