Claims Management 101 for the Safety Professional

Jolene Donahue, CSHS, OT, AIC, AIS The OSHA Connection, LLC

303-908-5506 or 1-877-646-4974 9035 Wadsworth Parkway Ste. 3440 Westminster, CO 80021

WELCOME What to Expect

Techniques *Save money *Lower Injury Rates

Case Law and Case Studies

!IMPORTANT!

It is never acceptable to discriminate against or

terminate someone for reporting an injury or filing a workers’

compensation claim.

Lag Time Number of days between

oEmployee: An injury and when employer notified

oEmployer: When notified and reported to insurance

Lag Time Colorado – employer 10 days ; employee 4 days up to 2 years

Lag Time Praxiom – 33% more costly after 24 hours. AMAXX – 35% more costly after 24 hours vs 45% more costly at 4-5 weeks. 22% litigated within 10 days vs 47% after 31 days. NCCI (Nat’l Council Comp Insurance) – 44 states 35% increase after 14 days vs 47% after 28 days.

Medical Treatment “Right to Direct” choice from employer selected panel

Medical Treatment Employee may not be paid Date of injury To/from appointments During appointments

Employee Responsibilities

• Complete tasks assigned

• Bring in physician note after each appointment

• Attend every appt (both Dr & PT)

• Adhere to work restrictions 24 hr/day

• Cannot decide what tasks to do while restrictions assigned

• Maintain confidentiality

Employee Responsibilities

• Follow policies & procedures: o Cannot call-in “in pain”

(send to the treating provider)

o Can call-in “sick” (follow company policy)

o Can take “vacation” (follow company policy)

o Cannot decide when to terminate treatment

o Advise of any concerns or questions

Claim Coordinator Responsibilities

• Document

• Be consistent and fair

• Enforce policies

• Stay in contact with injured worker

• Notify the adjuster of any concerns, change in

status, all attorney correspondence

Claim Coordinator Responsibilities

• Actively manage all open

claims

• Gather/maintain all paperwork and treating provider notes

• Maintain the OSHA 300, 300A and 301

• Neutral party

Safety Professional

• Document! Document! Document!

• Fact finding

• Thorough

• Root causes

• Identify, eliminate and prevent

• Retrain

HIPAA Health Insurance Portability and Accountability Act • Federal Privacy Rule

• Does not apply

o Work Comp insurers o Work Comp administrative

agencies o Employers

• Safety Violations

• Positive post-accident drug or alcohol screens

Drug/Alcohol & Safety Policies

Drugs / Alcohol

Drug and Alcohol testing Company policy vs. law

• Even if late report • Even if seeks treatment later • Even if treatment sought, before

next appointment • Results may affect benefits • Results may affect employment

BE CONSISTENT!

Not everything that happens “at work” or “on the job” is considered Workers’ Compensation

(But sometimes it does)

Contact your adjuster for any of the following

Statutes and Compensability

Spiders/snakes/bees/etc

Anytime/Anywhere

Aggravations / Pre-Existing

Stress and Mental Health

Voluntary Participation

Food/Drink (prep and consumption)

Personal Tasks (medication or deviation)

Cold, Flu, Contagious Disease

Travel

Intentionally self-inflicted

Clumsy or Less then Brilliant

Work from Home

QUESTIONS

The OSHA Connection, LLC is a privately owned company and is not affiliated with OSHA nor any regulatory agency. Participants are always encouraged to review the standard(s) and interpretations from OSHA directly or at www.osha.gov Copyright 2016