Springfield, MO

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Proper management can help simplify claims

Posted online

by Annette England, R.N.

for the Business Journal

With the ever-increasing cost in health care, it's no wonder there is always a multitude of cost-containment issues where your workers' compensation claims are concerned. Although statistics show that workers' comp claims are at an all-time low, this can unfortunately be offset by the high cost of mishandled claims. Responsibility of cost savings rests upon the employee, employer, insurance adjuster, case management and the various other health-care professionals involved in the workers' compensation claims.

Savings starts with the employer/employee relationship. It is the employer's responsibility to educate the employees on a regular basis to the safety issues of each vocation.

Depending on how large the company is, the employer should have a health/safety coordinator, or designate an employee to be responsible for educating and keeping abreast on the latest OSHA regulations. The health/safety coordinator should be responsible for holding health/safety seminars, to educate the employees on policy and procedures, on a regular basis. You can obtain information from numerous resources such as OSHA and CDC, or obtain literature and statistics from National Institute for Occupational Safety and Health (NIOSH). NIOSH can be reached at 1-800-35-NIOSH, or visit the NIOSH homepage at

When dealing with the injured worker, a light-duty program enforced by the employer has proven to be a significant factor in reducing the overall cost of claims. If you are serious about cutting work- comp cost, it is imperative that a light-duty return-to-work program be implemented. The health/safety coordinator should be aware of and comply with restrictions given by the physician, and communicate with case management, health care professionals and insurance adjustors. This also helps make the transition to full-duty work substantially less stressful for the injured worker.

The employee must actively communicate to the employer any identifiable and potential hazards in the work environment and collaborate to correct these situations immediately. It is very important to involve the employees as a part of this process by getting them active on a safety committee and giving them a sense of control and responsibility over their work environments. This enlightens employees to awareness and education, thus creating greater efficiency and self-confidence. The communication between employer and employee is essential in order for there to be a successful, safe working environment.

To help negate any confusion and receive prompt and efficient medical treatment when an injury happens, the guidelines set forth by the employer and health/safety coordinator must be clear and concise, educated frequently and documented. It is a worthy practice to have injury drills so that questions can be aired and addressed at that time. Knowledge and preparation can be a life-saving factor. When the claim is handed over to the insurance adjuster, the adjuster can help with cost-containment issues by simply being educated on the latest trends and developments in the health-care industry.

Most insurance adjusters choose to keep abreast on trends and current issues by attending seminars and reading the latest mountains of literature available on these issues. Also available are current updates that will be e-mailed to you, thus keeping you current on the latest trends. Health Insurance Association of America is one organization that will e-mail regular updates on the latest trends and issues.

It can be reached at

When looking at cost-containment issues in workers' compensation claims, there is significant evidence of cost reductions through implementation of managed-care strategies involving on-site case management and pro-active safety/health education. This has proven to lower expenditures by some 50 percent vs. non-managed care programs. There is improvement on lost time from work and treatment outcomes by ensuring the injured worker receives an appropriately aggressive treatment plan geared towards his or her optimal recovery from the work-related injury and allowing the person to return to work as soon as possible. The end result is better employee moral which equals improved employer/employee relationship and performance.

On the flip side of these issues is workers' comp fraud. Implementation of a good case-management program can help identify and alert any red flags that may present themselves.

Clear communication between the employer, employee, case manager and adjuster is of the utmost importance to reach the desired goals and outcomes of efficient medical care and facilitate the return-to-work process. With an aggressive approach to treating the injury as soon as possible, you ensure the injured worker doesn't fall through the cracks and get lost in a sea of follow-up appointments, second opinions, misdiagnoses and diagnostic testing, thus increasing employee frustration, medical cost and lost time.

(Annette England, R.N., is founder and president of Kelnett Inc., a professional case-management services company.)


It is a worthy practice to have injury drills so that questions can be aired and addressed at that time.


Getting employees involved in a safety program and keeping them educated on procedures are key components to workers' comp cost containment, Annette England said.[[In-content Ad]]


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