Proactive Claims Management: How It Saves Businesses Thousands on Workers' Comp
Workers' compensation is something that every business wants to do right. But there is an important balance between compassionately caring for your injured workers and being defrauded with inflated or even false injury claims.
Many businesses who do not have the time or on-staff expertise to proactively manage workers' comp claims wind up paying thousands more than necessary in premiums every year, sometimes just from one fraudulent claim.
At the same time, you may risk higher turnover and reputation damage if genuinely injured workers cannot get what they need because previous claims have made approval more challenging.
How do you walk that line between being responsible and compassionate without becoming a target for fraud? The answer is proactive claims management for every workplace injury.
What is Proactive Claims Management in Workers’ Comp?
Proactive claims management means that professionals who understand the process will help optimize investigation, treatment, recovery, and return-to-work planning for every injured member of your team. This process is helpful for any business but is especially important in high-risk industries where injuries are both common and must be well handled.
The proactive claims management process focuses on accuracy and rehabilitation. Employees with a legitimate injury who aim to return to work as quickly and completely as possible will receive all the care and attention they need. Return-to-work plans will be created in alignment with medical advice, and the employee will be back to full hours and pay as soon as they can.
Of course, with thorough and closely monitored attention paid to every workplace injury claim, the process can also quickly reveal the details of false, fraudulent, or inflated claims.
The Proactive Claims Management Process
Proactively managing a workers' compensation claim involves close involvement with each case every step of the way. While most companies do not have the time or expert staff available to provide this level of attention, hiring a third party with a robust claims management process can both help your injured employees receive better care and protect the company from fraud through the same level of dedicated detail.
Here's a quick outline of how each claim is managed:
- Manage the Initial Report of Injury
- Work with a medical provider
- Communicate with the employee
- Establish a Plan to Manage the Claim
- Gather Documentation About the Claim
- Determine eligibility and also any potential subrogation.
- Investigate relevant facts, if necessary
- Request independent medical consultations (outside of the insurance provider)
- Additional medical exam, if warranted
- Monitor employee as they return to work
- Build a return-to-work plan
- Facilitate Return to Work
- Increase workload as recovery allows
- Manage Rehabilitation and Recovery
- Track employee's rehabilitation progress
- Provide for recovery needs
- Review Case & Manage Reserves
How Injured Employees are Helped by Claims Management
Closely monitoring an employee's injury and recovery process ensures that every injured employee receives the care and attention they need as they return to work. They will be allotted time and resources for treatment, assigned the right level of light work in recovery, and their progress will be celebrated as they heal.
Claims management can ensure that injured employees file an injury report immediately, receive a thorough and documented medical assessment, and build a comprehensive recovery plan. They will help ensure that legitimate injury claims are accepted and that employees receive the support they need while minimizing the time an employee must spend on reduced pay during recovery.
Employees will find that their full rehabilitation is a company priority and that any lingering symptoms that are medically documented are taken seriously so that support equipment and considerations are provided, as needed, to prevent a follow-up injury.
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How Companies Are Protected Through Claims Management
Of course, proactive claims management places the magnifying glass over potentially fraudulent claims. In seeking the best and most complete recovery for injured employees, a claims manager can also reveal when an injury or treatment plan is exaggerated - either by the employee or even a medical practitioner looking for an extra insurance payout.
By ensuring accurate documentation and closely monitoring an employee's recovery progress, fraudulent claims are shaken out, saving the company thousands in claims for medical services and disability pay.
Why AEOs Thrive at Proactive Claims Management
Most companies struggle with workers' compensation because interests are not aligned. PEOs and state funds do not prioritize claims management because their finances are not at stake. Self-insured organizations, however, are responsible for paying claims and therefore are more watchful of the claims process. The responsibility acts as an incentive to achieve the best possible outcomes without waste.
AEO stands for Alternate Employer Organization. This type of HR provider never shirks the responsibility for a workers' compensation claim because they are self-insured. Handling workers' compensation on behalf of other companies falls within an AEO's purview, taking on full responsibility for the costs. This leads to greater dedication to balanced quality of care and vigilance against unnecessary losses due to fraud. This can have an immediate positive impact on your workers' Compensation premiums.
Instead of claims being paid from a state fund through a third party, the AEO pays your claims through its own claims fund. As the AEO is responsible for all risk, they are proactive and watchful of all steps in the claims process. By definition - by the very way they are set up - the AEO only succeeds when their customers succeed.
As the AEO owns the risk, your claims are managed to the best possible outcome, quickly and without unnecessary waste. By minimizing malingering cases, reserves also decrease, which can lead to even lower premiums in the future. You achieve short-term cost reduction, complemented by long-term cost control.
Improve Your Workers’ Compensation Efficiency with Alloy Employer Services
When you work with Alloy Employer Services and our proactive workers' compensation claims management process, you can achieve both short-term cost reduction and long-term cost control for workers' comp premiums without sacrificing the quality of care for your injured employees. Contact us today to learn more.
