Practical
Tips and Tools For Effectively
Managing Worker’s Compensation
Cases
Why manage work related injury
cases?
• Emerging risks/trends
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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
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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?