vsdp and workers compensation kitty hughes workers compensation services

VSDP and Workers’ Compensation

Kitty Hughes

Workers’ Compensation

Services

Program Overview GOAL

STD claims -Provide agency with VSDP coordinated approvals on occupational cases. LTD claims – Provide IWs with direct LTD benefits and supplemental benefits on occupational cases.

Reporting the claim• Workers’

Compensation• MC Innovations

– Submission via Visual Liquid Web by agency representative

– Mandatory submission by day 10 post injury

• VSDP• Reed Group

–Submitted by member or anyone on their behalf

–14 day look back from date reported

Workflow Process• New claim process

• Pending claim process

• Ongoing approval process

• Denied claim process

New Claim – WC/VSDP• Agency submits WC claim via VLW• Benefit Coordinator initiates WC investigation• IF IW initiates claim with Reed Group

– Reed Group sends Althea an email for information• Enters Reed Claim Number in WC system• Notes eligibility VSDP File (Yes) field• places DBS in responsibility tab• sets a diary for the BC• Enters a VSDP note in the claim system• Report generates to assigned DBS next business day

Althea adds Reed Claim Number

Adds VSDP Filed - Yes

Disability approval updated

Add the DBS Name

Sets a diary for follow up

Pending claim process

• Weekly review of WC file status on diary• WCS notifies Althea if comp decision is

made in between diary dates• Althea updates the VSDP status via

VSDP file note (for overnight transmission)

Reed processes disability claim while WCClaim remains in a WC Pending status

Ongoing disability approvals

• Disability approvals are scheduled by:– BC or Althea– Based on the next treating physician’s office

visit (NOV)– Anticipated length of disability– Claims activities on file (such as IME,

surveillance or vocational compliance)

Denied Claims

• Denied claim compensability – reported to Reed Group via VSDP daily report

Denied ongoing approvals based on:Settlement of claimFailure to cooperateRefusal of medicalDisability from unauthorized physician

Communication is the key

• Accurate facts

• Opportunities/options

• Optimal medical outcomes

• RTW facilitation

Agency Interaction

• Knowledge of process

• Who do you contact?– vdpsupport@reedgroup.com

– Workers’ Compensation• Althea Burnett (804) 786-9862 althea.burnett@yorkrsg.com

What you can do to help

• Provide RTW updates to both TPA’s• Provide Wage and Supplemental Reports• Encourage IW to report claim to Reed

Group timely• Forward medical notes/disability slips• Track and share LTD date• Contact TPA if approval is inaccurate

Goal – Universe in Harmony