Workers' Comp Spotlight: Prompt Claims Reporting

Posted by Lori Gibowski on Feb 16, 2022 8:30:00 AM

West Bend’s Workers’ Compensation Claims department is dedicated to helping our policyholders reduce rising medical and disability costs. From the moment we receive a claim, we begin to implement a great number of cost containment strategies. The success of these strategies is inherently tied to the adjuster’s early involvement and intervention in the claim. Here are a number of ways that our adjuster’s early involvement and intervention help decrease claim costs resulting in lower workers’ compensation premiums for our policyholders. wc claims reporting

With prompt reporting, claim adjusters are able to:

  • Minimize the risk of the injured worker becoming attorney-represented by promptly contacting the injured worker and explaining workers’ compensation claim benefits as well as the claims process.
  • Provide injured workers with a customized road map of all medical cost containment programs to ensure early use of these programs and emphasize the importance of Early-Return-to-Work.
  • Implement our prescription drug card program which provides:
    • Direct pharmacist interaction
    • The ability to track prescription history and usage
  • Aggressively implement our narcotic program, thus minimizing narcotic usage and mitigating costly prescription costs and dangerous risks.
  • Immediately access a team of dedicated staff nurses to help with aggressive medical and disability management.
  • Use a collaborative approach with the employer to implement an Early-Return-to-Work program. Return-to-Work before the end of the waiting period may prevent a lost time claim altogether.
  • Utilize a certified occupational medicine physician advisor to help determine etiology, causality, and nature and extent of injuries.
  • Review all medical bills for accuracy, reasonableness, and necessity.
  • Access comprehensive Preferred Provider Organization (PPO) networks to achieve the highest possible reductions on our customer’s medical and surgical bills.
  • Obtain durable medical equipment discounts through our preferred providers.
  • Channel physical therapy and chiropractic treatments through our physical therapy and chiropractic programs, evaluating utilization and costs.
  • Direct or soft channel costly diagnostic procedures through our provider networks resulting in significant cost savings.
  • Promptly refer injured workers to skilled nursing facilities (post-acute care) if needed; West Bend works with a vendor that negotiates discounts and monitors treatment to ensure injured workers are receiving the appropriate care for their injuries.

These initiatives, if executed timely and consistently, will decrease the medical and disability costs of a claim. It’s important for policyholders to report new claims timely, which will ensure the earliest possible intervention by our adjusters and the application of our many comprehensive cost containment programs and initiatives.

Prompt reporting also eliminates the potential for fines imposed by the states in which we conduct business. Prompt reporting truly makes a difference!

This article is intended for general educational and illustrative purposes only and should not be construed to communicate legal or professional advice. Further, this article is not an offer to sell insurance. Please consult with your licensed insurance agent for specific coverage details and your insurance eligibility. All policies are subject to the terms, conditions, limitations, definitions, and exclusions contained therein.

Topics: Workers' Compensation

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