As premiums rise, employers look for ways to improve their risk profiles and control their costs. Pricing pressures come from many angles – medical inflation, claim severity, Medicare set asides, state regulatory changes and lagging investment income from low interest rates. In addition to fairly aggressive price increases, insurance companies are increasingly selective about which accounts and risks they will underwrite. Employers looking to better position themselves focus on the fundamentals of reducing Workers’ Compensation costs:
• Loss prevention and control • Managing claims
• Return to work programs • Improving the outcomes for medical care
• Measuring and tracking results • Training, education and communication
• Wellness initiatives
Yet, even employers with a strong commitment can struggle to achieve long-term, consistent progress in cost containment. To be successful requires rigorous oversight, coordination and constant vigilance. Employers who carefully select partners, establish a coordinated framework, set expectations for each stakeholder and monitor results are in the best position for success.
Here are some expectations and red flags that can help guide the process:
Claims adjuster/Insurance carrier
• Ensure proper administration of all Workers’ Compensation claims, setting a strategy for the proper management of a claim in collaboration with the employer, health care provider and employee
• Maintain communication with the injured employee, health care provider and employer
• Provide analytics on injury trends, medical outcomes and recommends individualized, cost-effective programs to reduce injuries
Red flags: failing to investigate thoroughly; sloppy documentation; billing errors; failure to read medical reports, monitor and control medical treatment, and understand employers’ return to work program; frequent changes of adjusters; inconsistent or unacceptable reserving practices.
Health care provider
• Provides appropriate, effective medical treatment that facilities recovery and expedites return to productive work
• Work with the employer to encourage appropriate recovery and work opportunities
• For complex cases, integrates care for the entire case including specialty providers and ancillary services such as equipment and transportation
Red flags: Treatment inconsistent with evidence-based guidelines; dispenses drugs, including opiates, from office; allows employee to direct care; broadens scope of treatment beyond the injury; billing errors; does not provide timely reports or appointments;
Injured employee
• Know and follow safety procedures • Report injuries immediately
• Keep appointments and follow doctor’s orders and restrictions
• Notify supervisor immediately if work status changes
Red flags: provides conflicting versions of injury; injuries are inconsistent with nature of accident; refuses medical tests or exams; injury is not reported in timely fashion; refuses contact with supervisor and colleagues
Employer/Supervisor
• Educate all employees about Workers’ Compensation, proper reporting of incidents and near misses, and incident investigation
• Report claims within 24 hours
• Develop and provide meaningful return to work opportunities
• Monitor and strategize how to resolve claims
Red flags: slow reporting of claims; a high percentage (over 20%) of lost-time claims; a high number of injuries among new employees
by Tom Champoux, CPCU, AIC, CWCA
UNICO Group, Inc.
402-434-7200