The workers' compensation injury reporting process faces many challenges: injuries are reported late; claims contain incomplete information; and lags in communication lead to less than optimal financial, medical and return-to-work results.
To address these challenges, employers benefit most from a well-designed call-center solution. Today's most innovative call centers now employ experienced nurse professionals to not only perform the intake of injury reports, but also leverage their medical expertise to assess and triage injuries to the best, most appropriate level of care. In short, nurse injury reporting and triage services help set workers' compensation claims on the right course from the start.
Health plans have long used nurse hotlines to provide members with medical advice and to foster proper utilization of healthcare services to control costs. Workers' comp programs are now leveraging this strategy to reap similar savings.
Unlike nurse case managers, a triage nurse gets involved much sooner in the workers' compensation process, essentially at the point of injury. An injured worker or supervisor calls the toll-free number immediately following an incident. Whereas in the past there were often delays due to a lack of communication or stalled paperwork, utilizing a nurse call center is so simple and easy it usually increases same-day injury reporting to 100 percent compliance.
A key advantage for employees is they receive a highly personalized and compassionate response to work-site incidents. Nurses listen closely to the nature of each injury and focus on the employee's unique medical needs. As a result, employee experience is overwhelmingly positive, resulting in increased satisfaction and a decreased rate of litigation.
Traditionally, employees and supervisors filled out and submitted claim forms. Because they were not experienced in capturing claims information, adjusters often spent days tracking down additional details. Triage nurses, however, are trained to perform thorough questioning in order to gather comprehensive data, streamlining the claims process.
In addition, the call center handles all required paperwork. Within minutes of an incoming call, the nurse sends the first report of injury by e-mail or fax to the supervisor, physician and claims administrator. Immediate dissemination of the injury report enables each stakeholder to initiate their respective roles in the workers' compensation process and to optimally impact the claim's outcome.
In the past, supervisors directed injured employees to a healthcare facility. However, managers are not trained medical professionals and should not be expected to make medical decisions. In most cases, they erred on the side of caution, sending employees--even those with minor injuries--to the emergency room, a costly and often unnecessary level of care.
Triage nurses have the medical expertise to ensure each injury receives the care and treatment appropriate to its level of medical severity. In severe cases, a nurse will advise emergency care. With minor injuries, the nurse may channel the employee to an occupational clinic in the employer's preferred provider network, or may provide simple first-aid or self-care guidelines over the phone.
After speaking with a nurse, 20 percent to 40 percent of employees do not require or request additional medical services. As a result, many organizations reduce their compensable claims by 20 percent to 30 percent.
The nurse call center also works closely with an employer's RTW program in building an online database of essential job descriptions and transitional work assignments, ready to be utilized when an injury occurs. Integrated injury management and RTW coordination enable employers to facilitate safe and prompt RTW results, which have reduced lost time by as much as 50 percent.
In summary, a nurse call center enables timely injury reporting, appropriate medical care and improved RTW outcomes. Leveraging the medical expertise of triage nurses, employers have decreased overall workers' compensation costs by 10 percent to 30 percent. In addition, these organizations send a clear message--that they care about employee health, safety and recovery.
PAUL BINSFELD is the CEO of Company Nurse, a firm specializing in workers' compensation injury triage and management.
July 1, 2008
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