Embed Size (px)
DESCRIPTION
As a claims manager my goal was always to return the employee to their pre-injury job with no restrictions and no risk of further injury. Employers should always develop a clear goal for injured employees with reasonable time frames. Once the rehabilitation plan has been developed and signed off it becomes the employer’s responsibility to ensure the plan is executed. In other words, the employer must manage the claim. A wealth of knowledge was obtained in enrolling small companies in Texas HCNs. In 2012 began work at Travelers Insurance as an investigator. For more details :- https://www.facebook.com/patricenhall1
Citation preview
Patrice N Hall – Tips For Claims Management
Understand the roles and responsibilities of all parties involved
All parties involved, including supervisors to the union steward, to the physician and treating therapists, the WSIB claims manager, the joint health and safety committee, and even other uninjured employees have critical involvement in managing claims. Clearly defined roles and responsibilities is an employer resource, allowing them to intervene if someone is not doing their job.
Action: Develop a program that clearly defines the roles and responsibilities of all parties.
Make Sure Everyone Understands Their Roles And Responsibilities
As an employer, you must ensure you have trained your employees on their roles and responsibilities under your RTW Program. Medical professionals need to be informed of your program and their roles; this is often done via letter attached to the functional ability form. WSIB must be aware of your program and that you are actively monitoring all parties. Action: Communicate to and train all applicable parties on their roles and responsibilities. This is a significant step towards good claims management.
Document All Injuries
The legislation clearly defines what an injury is and what your reporting responsibilities are as an employer. There are situations where an injury is so minor that it does not require the filing of a Form 7, but employers must keep a record of the minor incidents and ensure that the employees recover fully. Action: Ensure your documentation is in compliance with legislated standards.
Report Everything
Sometimes an employee will indicate that they do not want to file a claim or an employer does not feel that the injury warrants a claim. These are not your decisions to make. File all claims and allow WSIB to decide what claims are allowed. Failing to report injuries will result in greater long-term loss than any perceived short-term gain.
Action: Report all claims to WSIB regardless of your opinion on the claim.
Do Not Coach Employees On Filing Claims
Whether an employee chooses (or not) to file a Form 6, follow up with a physician or attend an appointment, it is their decision. This decision should not involve or be influenced by the employer. As an employer, you need to encourage the employee to follow the appropriate steps when reporting and recovering from an injury.
Action: Encourage employees to follow appropriate steps, but do not influence/interfere in their decisions.
Treat Work-related And Non-work-related Claims Equally
Lost time injuries and non-work-related injuries should be managed in the same manner. If an employee hurts his or her back at home and is allowed to take six to eight weeks off?Employees could view this as unfair practice and refuse to participate. This can result in complicated claims and conflict among the company, the treating professionals and the employee.
Action: Ensure your RTW program looks at all employee injuries, regardless of source.
Patrice N Hall Tips For Claims Management
