“Blue, Silver & Gold”: The Color of Claims Best Practices, I’m Told
The opening lyric from “Silver, Blue & Gold”, an old rock ballad by Bad Company goes like this: “In the beginning, I believed every word that you said. Now that you're gone my world is in shreds…” That’s a sentiment many supervisors, managers and safety professionals can identify with, especially if a seemingly minor work-related claim has “unexpectedly” gone wrong. An informal means of dealing with back strains, muscle pulls or other “minor workplace injuries” can result in lost-time claims adding up – and your work comp world can indeed end up “in shreds”.
The term “gone wrong” refers to a number of outcomes including, but not limited to, days away from work, lost-time wage benefits, “light-duty”, multiple follow-up medical appointments, the employee has been seen working (even though they’re out on work-related disability), and the list goes on and on. Safety and Claims professionals concur that only by having a specific management process in place, can an employer greatly reduce the chances of things going wrong with a seemingly minor work-related injury.
Claims management involves key steps that must be carried out by the employer, injured worker, medical provider and insurer. MEMIC has condensed the most important claims management actions down to eight specific factors in their online document, Return to Work; How to Implement a Best Practices Program. Like the title of the old Bad Company song, MEMIC uses the colors blue, silver and gold to designate the progress that a company is making towards excellence. Here’s an overview of the best practices.
- Return-to-Work Policy – This written policy doesn’t just sit on a shelf. It details the overall business philosophy for keeping injured employees at work whenever possible and includes a policy statement that can be found in the employee handbook. It is posted in the workplace and is included with correspondence to medical providers.
- Coordinator – Specific employees, primary and backup, are designated to ensure that administrative aspects of an injury are addressed effectively. Vital roles include filing the claim with insurance provider(s), scheduling medical appointments, and maintaining and filing all correspondence related to a work-related injury.
- Training – All employees receive documented training in the company Return-to-Work Policy at time of hire and annually after that.
- Job Descriptions – Written for all positions, these descriptions include physical capacity requirements to include such factors as percentage of day standing, sitting, walking, reaching, etc. The working conditions (office vs. production) and the amount of weight required to lift during a typical workday, maximum and average, are also included.
- Preferred or Occupational Medical Provider – A formal relationship is established with a medical provider for all the employer’s locations. Regular employer/provider meetings are conducted (at least annually) to ensure the medical provider understands the workplace and the employer’s commitment to keeping workers on the job. The medical provider relationship is included in the employee handbook and is posted in the workplace.
- Medical Provider Communication – Following a work-related injury, the medical provider communicates clear written instruction to the employer on restrictions for transitional duty and a schedule for follow-up visits.
- Transitional/Modified Work – All restrictions are accommodated within guidelines that are established by the employer. A “catalogue” of transitional/modified work is maintained for commonly encountered restrictions such as limited lifting, bending, reaching overhead, etc.
- Transitional Assignment – Transitional/Modified work is communicated to the employer through a formal restriction agreement. This document details all restrictions, including detail on follow-up medical appointments and has acknowledgement sign-off areas for supervisors and the injured employee. Specific guidelines are established for the duration of the transitional assignment and its relationship to the Family Medical Leave Act (FMLA).
When it comes to lost-time injuries, if you feel like Bad Company, that your “Ray-ay-in bow is overdue”, take a few minutes and compare your company’s method of handling injuries to MEMIC’s Return-to-Work Program rating sheet. For more information on how to effectively manage claims, go to MEMIC’s Manage Claims webpage.
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