The Person Behind the Claim: How Chick-fil-A’s Team Found the Workers’ Comp Recipe for Success
A new claim is reported, and it has some red flags, so a call is made to a trusted defense attorney. She suggests there is a 50/50 chance that a judge will rule in favor of the employer, so why not deny the claim and attempt to settle it cheaper?
Claims professionals are often faced with this scenario, and it’s the reason why there are so many horror stories about workers’ compensation.
So often we focus on loss runs, spreadsheets and numbers, forgetting there is a person behind each claim; an individual who went to work with the expectation of arriving home in the same condition they were in when they left their house. Most employees have never had an accident at work and don’t know what to expect or how to proceed.
Due to the time constraints placed on claims professionals today, there is a need for a program that allows the injured party to have access to basic workers’ compensation frequently asked questions while providing quality medical care.
Since it’s not easy to inspect each doctor’s office on an approved panel, risk professionals should lean on partners to give honest feedback about the user experience.
An injured worker shouldn’t have to settle for subpar medical care; if you wouldn’t go to the facility yourself, why would you send your employee?
Consult with nurse case managers, local employer units and/or team members to explain what they like and don’t like about a clinic.
Encourage the use of a clinical consultation line, which will put the injured employee in touch with a live nurse who can triage the injury immediately and help get the injured party to the appropriate level of medical care.
This reduces time away from work and allows for the clinic to procure the insurance and billing information prior to the appointment.
The best claim isn’t the closed one, but the one that never exists. True savings on a claims program won’t come from paying $10 less per diagnostic test but from preventing an injury from occurring.
As soon as that claim is filed, the employer or carrier will be spending money.
Therefore, the focus should be on the quality of care provided to the injured worker and learning from the behavior that caused the injury to prevent reoccurrence.
Often, it’s easy to forget the positive impacts that claim professionals can have on a life. When the focus shifts from financial costs to the overall claim experience, differences can be made.
About five years ago, there was a horrific injury where a young 20-something was paralyzed from the waist down. The adjusting team and carrier came together, agreed this was a claim that needed to be accepted and to provide the best care possible.
The injured worker went to a premier spinal cord rehabilitation program, and as a result of these actions, he is walking today.
To see a young man now living a relatively normal and healthy life with an incredible career all these years later came at a great financial cost.
The investment made in his life, however, is immeasurable. &