Risk Insider: Dan Holden
Do Your Homework
My years reviewing claims files drives me to the following conclusion: unless the employer is prepared, they’re wasting their time sitting through a workers’ comp file review.
While it seems like common sense, you’d be surprised how many employers don’t do their pre-work. Many times I’ve seen an employer sitting in the meeting nodding approvingly while the examiner provides a lackluster or imprecise update.
The employers – not being experts nor adequately prepared – don’t know the difference. And because they allowed themselves to be bamboozled, the file review is basically for naught.
I’m not saying file reviews are total rubbish. The mere fact that you requested the file review shows you are at least interested and will motivate the examiners to update their files.
But a file review will only scratch the surface. You might as well rename the file review, “Tell-me-what- you-want-me-to-know-in-3-minutes-or-less.”
I always advocate for an actual file audit on occasion to supplement your quarterly file reviews on all high value/high exposure cases. When it comes to a file audit, there’s no place to hide. Stone after stone will be unturned, so no doubt will remain as to whether the file was handled properly.
Often what the examiner tells you – and what the file ultimately reveals – are completely different. This isn’t a way to “catch” the examiner slacking, but rather to find out if your money is well-spent on that particular examiner, or more importantly, on that third-party administrator or insurance carrier.
I always advocate for an actual file audit on occasion to supplement your quarterly file reviews on all high value/high exposure cases.
So what constitutes “pre-work?”
It all boils down to how much you know about the injured worker. Do you know his diagnosis and the effectiveness of the treatment regime? The treating physician? What’s the return-to-work situation? Claimant attorney? Employee’s work history? Personnel history? Medical history?
Did the examiner establish a plan of action and stick to it? Did he share that plan with you prior to the review? Most importantly, did the examiner continually move forward in regards to file management and expedition to closure?
Some employers would say, “why would I need to know all that when the file review will tell me everything I need to know?” If that’s the case, I’d suggest you go back and read the first paragraph. An employer can’t be an active participant if they don’t know what they’re dealing with.
You must also remember you’re most likely sharing the examiner with several other employers, and the examiner only has so many hours in a day. His/her time will be focused on the employers who either squawk the most, or (and this is crucial) closely follow their files.
Disinterested employers will always fall to the wayside. And, yes, it will take time to keep up to speed on the claims. But it’ll pay dividends when it’s time for the file review because you’ll be a functioning part of the decision-making.
So be interested. Be involved. And do you pre-work. If you’re not prepared, it’s pretty easy for an examiner to gloss over prior missteps.
Read all of Dan Holden’s Risk Insider contributions.