Workers’ Compensation Claims Mounting? A Collaborative Review Process Can Help

By: | December 10, 2021

Michele R. Punturi, Esquire, is the Director, Workers' Compensation Department at Marshall Dennehey Warner Coleman & Goggin, P.C. She can be reached at [email protected]

The cornerstone of every business is to operate efficiently and in a fiscally responsible manner.

In the workers’ compensation industry, employers, insurance carriers and third-party administrators have slowly, but surely, veered off course with a lack of communication leading to increased costs and reduced revenue.

The gravamen of the underlying issue is a lack of collaboration between the stakeholders during the pre-litigation and litigation phases of a claim.

There is such an incredible opportunity in workers’ compensation to bring key stakeholders together and improve the claims handling process. Each player on the claims team, including the employer, carrier/third-party administrator, broker, medical team and attorney, can lend insight into areas to change and/or improve. As Helen Keller so eloquently posed, “Alone we can do so little; together we can do so much.”

After defending workers’ compensation claims for 30+ years, I continue to see areas where properly trained staff, skilled in delivering positive and consistent communications, could have prevented a claim or at the very least, limited its exposure.

By using a claims review approach aimed at developing a comprehensive team, relationships will be forged toward a common goal that can dramatically impact the bottom line.

Conducting periodic claims review meetings (either monthly or quarterly) will keep the lines of communication open and move the claim in a positive direction. Not only are these meetings critical during the litigation phase, but they are also just as important in the pre-litigation phase.

Such communication will help to identify areas of importance and reveal the critical decisions and actions that should be taken to improve chances of limiting exposure of the claim.

While the workers’ compensation system varies from state to state, taking a proactive approach in the workplace is a universal tenet that can help to control exposure.

Employers who work with their carrier/third-party administrator, broker and attorney to ensure that claims with potential high wage loss and medical expenses are handled timely will strengthen their defenses.

Oftentimes, the stakeholders on the team are not working together, or are not part of the process, when critical information such as the exact mechanism of injury, witnesses, identity of any violations of the employer’s safety protocol, and management and control of medical treatment are discussed.

If these activities are coordinated amongst the team, claims will be handled more effectively and efficiently.

It’s time to work better and smarter. Utilizing claims reviews as an effective case management strategy is a sensible and necessary approach that can help to limit exposure, reduce costs and ultimately, close files. &

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