Introduction to Effective Medical Claims Management

1. Introduction to Effective Medical Claims Management Presented by Dianne Lindsay Workers’ Compensation Services

2. How time off impacts your place of business • Loss of experienced employee(s) • Hiring and/or training of replacement workers • Extra labor costs • Loss of productivity • Workflow disruption • Supervisor distraction Workers’ Compensation Services

3. The importance of employer involvement • Claims costs impact the amount you pay for workers’ compensation • One claim can prevent your from being eligible for group rating • An increase in premium from an adverse claim can impact your rates for 4 years Workers’ Compensation Services

4. Importance of Employer Involvement • Ensuring prompt reporting • Educating supervisors and staff • Individualized reporting packets • Identification of potential safety issues Workers’ Compensation Services

5. Importance of Employer Involvement • Maintain contact with IW • Development of preferred provider network • Contact with Provider • Job Descriptions Workers’ Compensation Services

6. Importance of Employer Involvement • Accommodating restrictions • Modified work • Salary continuation • Identify barriers to RTW Workers’ Compensation Services

7. VocationalRehabilitation • 15k program-Pros & Cons

8. Red Flags • Relationship of accident/incident unclear • Treatment is excessive and/or exceeds nationally accepted treatment guidelines • Continuous medical/chiropractic treatments without documentation of improvement Workers’ Compensation Services

9. Red Flags • Multiple medical providers, ancillary services and ER visits • Medical and non-medical issues seem to complicate recovery • Delay in return-to-work Workers’ Compensation Services

10. Red Flags • Pre-existing conditions • Multiple medical conditions and diagnoses and treatment is excessive or unusual Workers’ Compensation Services

11. Red Flags • Recovery is slow without medical indication • Unable to contact Workers’ Compensation Services