BKS Partners Workers' Compensation Blog

Best Practices for Claims Reporting

Posted by Tim Liberty on Mar 14, 2017 3:35:28 PM
Tim Liberty

“Driver Joe Schmo was stepping out of his truck and fell to the ground.”

“Server Betty Lou slipped on some water and hurt her back.”

These are fictional injury descriptions, but are very similar to the descriptions that I see on a daily basis. The problem: these descriptions leave a lot to the imagination, and make it difficult for me (or an adjuster) to accurately picture the incident. When a claim is assigned to an adjuster they have to make a three point contact: calls or emails to the employer, the injured worker, and the medical provider. In doing so, they are looking to confirm the mechanism of injury is consistent with the diagnosis. For instance, if I see an injury description that says “worker was walking and felt pain in his/her knee,” and a doctor diagnosed them with a tear, I might question the diagnosis. How do you tear a muscle from walking? That would lead me to call the doctor to further investigate, or assign a nurse to follow-up. Without a detailed accident description it can be difficult for an adjuster or nurse to have a conversation with a doctor confirming a workers injuries

Have you ever heard the term “body creep?” No, it’s not that guy RIGHT BEHIND YOU!!! Body creep is when a shoulder claim turns into a shoulder and neck claim, or a knee claim that turns into a bilateral knee claim, and maybe throw an  or two in there. These incidents happen all the time in work comp. It is really frustrating when you get a worker almost back to work, then all of a sudden they need treatment for another body part. That means another 6 weeks out of work. To mitigate body creep a detailed accident description that lays out all the effected body parts can help.

“The server was carrying a tray to the back of the house with about 10 lbs. of empty dishes with her left hand when her right foot slipped on some standing water. She fell backwards and landed on her lower back but braced the fall with her right hand. She injured her right hand, lower back and right foot.”

Can you picture that description? It’s a little wordy, but if she tries to say later on that she hurt her head or neck, I would question her claim and be able to show the doctor a detailed description of what she initially said happened.

Claim investigations by frontline managers is critically important in workers’ comp, and can help to better manage claims

Join us for a webinar on March 23rd that will explore the best practices in claim reporting. Click here to register.

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The BKS Blog was written to keep you informed and help you learn about the changing landscape of workers' compensation insurance. These articles are written for employers who are researching additional information about changes, or looking to change their insurance partner.

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