Helping Injured Workers Quickly
Aggressive claims handling for workers compensation
By Eric Gilkey
Get a glimpse of why CLM’s Workers Compensation Community’s recent webinar, “Aggressive Claims Handling for Workers Compensation,” attracted more than 350 registrations.
Kirsten Kaiser-Kus, partner at Bryce Downey & Lenkov LLC
Penny Wright-McCloud, risk senior claims manager for Sunstate Equipment Co.
“Aggressive claims handling can be achieved on every claim with proper preparation and planning. It takes a team of professionals working together to get it right…[which] typically consists of a broker, TPA, and carrier. As an employer, utilize your risk management department and managers in the field. Don’t leave out employees…and a legal team defense member.”
“How you choose to handle a claim can significantly impact the outcome of the claim. Timely reporting is paramount. Through pre-game prep, your team members should know exactly what to do. The employee reports to the manager, the manager to the TPA or carrier, and that is where the communication, collaboration, and advocacy begins.”
“Be an advocate for early return to work, but be fair and consistent. As part of your pre-game work, you should have established an early return-to-work program and created that expectation with your employee, manager, TPA, and carrier.”
“Pre-injury preparation and investigation is so crucial because most of the time I don’t see these claims until a year or two later. Witnesses leave or become bitter ex-employees. So it’s very important to get all [loss information] immediately upon notice.”
“Aggressive claims handling isn’t about denying everything—there are legitimate injuries. What we need to do during an investigation is weed out what is legitimate and what is fraudulent so we can help these people. If you come off as skeptical or standoffish, the employee will offer less information. It’s true—you get more bees with honey.”
Surveillance video is huge. So many surveillance recordings are set for a 24-hour loop, so they are going to erase. So the minute you hear about a loss, pull the video. If the actual place they fell doesn’t have video, check surrounding businesses because they may have one that caught it.”
“I have industrial clients who have set clinics that are familiar with the type of injuries the company might have, and their medical management facility knows how to address these injuries. Just sending an employee to the emergency room is a disaster—they are going to do diagnostics, lab work, and this and that, and you won’t get the injury addressed properly.”
“Why do plaintiffs retain counsel? They don’t receive their temporary disability benefits timely, they don’t receive their prescriptions, or they don’t receive their medical treatment. If you have issues getting TPD out on time, put it on auto-pay. The last thing you want is a plaintiff’s attorney screaming, ‘bad faith.’”