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By VANCE ROOT, executive vice president with Avizent, a national provider of claims and risk management services based in Columbus, Ohio

When attendees to the National Workers' Compensation and Disability ConferenceŽ & Expo arrive in Chicago from November 18 to 20, one of the top issues on their minds will be how to maximize the value of their workers' compensation programs in today's uncertain economy.

CHIPPING AWAY AT SCHIP

With the help of TPAs and consultants, many employers are taking the necessary steps to meet the January 2010 reporting requirements for Medicare eligibles. While the basics of reporting may be understood, however, the full ramifications of the legislation are just now coming to light.

For example, employers are already reporting that claims are remaining open for longer periods of time, which can affect settlements as well as reserves and the balance sheet.

Presenters and industry experts in Chicago will highlight that taking aggressive steps to settle claims as quickly as possible, and to return injured employees to work quickly, will be critical to surviving under the SCHIP regulations.

UNDER PRESSURE: SUBROGATION

When the economy is tight, more employers and plan sponsors look to subrogation techniques to ensure they are exploring every fair and appropriate workers' comp claims resolution opportunity possible.

What many employers are finding, though, is that some partnership or vendor agreements they may have entered into in the past make it difficult to achieve fair subrogation for legitimate claims today.

Take as an example a large retailer that may have an agreement with a manufacturer saying it will be held harmless for any claims involving their product or service. In today's market, such arrangements should be much more closely scrutinized to ensure fairness and equity for both parties.

Achieving that goal will require more due diligence on the front-end to develop arrangements and contracts that are mutually beneficial--but which do not end up prohibiting an employer from pursuing legitimate subrogation opportunities.

High-end technology solutions and vendors with dedicated subrogation units and experts can help employers maximize subrogation opportunities. Look for them on the showroom floor.

BACK TO BASICS

When it comes to an effective workers' compensation program, the proven workers' comp fundamentals and a strong foundation matter. Now is the ideal time to revisit policies and procedures to ensure they remain up-to-date and relevant for the employers' current needs.

One key place to start is the first report of injury. Each company should have a detailed written report for first reports, as well as for first aid policies and procedures. Remind supervisors and employees to report all injuries--even if they do not turn into a claim--as they can help to identify potential problems and trends.

Hit up some of the other basic-level courses at the conference for more "blocking and tackling" tips.

BRING IN THE FIRST STRING

Upon first report of injury, one of the most important steps an employer can take is to bring in a nurse case manager as soon as possible. Nurses can help to ensure that the employee gets prompt attention from a trained provider and that the right treatment plan is put in place.

In addition, employers must ensure they communicate with providers in advance of workers' comp insurance claims to ensure they are aware of return to work goals, job descriptions and available modified duty positions. For claims that linger, bring in physicians or other clinicians to reach out directly to the treating provider to discuss ways to resolve the claim quickly.

TALK ABOUT IT

Yet another important step employers can take to improve their claims process is to ensure that they communicate clearly and often with all parties--from providers to employees to insurance carriers and TPAs.

Employers should request frequent reports on the number of open claims, status of claims and potential problems so that appropriate steps can be taken. As you work to improve communications, don't forget the most important participant in the system--the injured worker.

Develop guidelines for supervisors and other managers to encourage them to reach out often to the injured worker to ensure she is motivated and engaged in the return-to-work effort.

Don't forget to communicate with your peers in Chicago, at lunch, coffee breaks and other networking events, to see how they're handling this.

WHAT GOES DOWNSIZING ...

One of the findings from the recent downturn in the economy is that, when staffing levels are reduced due to downsizing, claims often increase. Organizations considering downsizing should alert their TPAs and insurers so appropriate steps can be taken.

Claims that occur during downsizing must have a heightened awareness of investigation and treatment. Employees likely will not be returning to work or light duty. Therefore, there needs to be a much more progressive deployment of resources in the first phases of the claim to facilitate prompt resolution.

Make sure to use all the resources that apply to your jurisdiction, including peer review, independent medical evaluation, utilization review and physician referral. Obtain medical evidence to support treatment protocols as quickly as possible and have a detailed outlined strategy to achieve prompt maximum medical improvement.

Conversely, remaining employees may be less hesitant to file claims in a down economy because of fears over job security. Employers may see a decrease in severity of claims, with a potential for an increase in frequency, particularly as employees pick up new job assignments and as they are learning new job functions.

Employers should note that some employees may be pushing themselves to the limit and that they are at risk for more severe injuries. Communication, reassurance, education and job training will be critical during this phase.

The above represents just some of the important information to be highlighted during the 2009 National Workers' Compensation and Disability ConferenceŽ & Expo. Be sure to identify your specific needs and attend as many of the relevant sessions as you can. Come prepared with questions to ensure you are able to maximize the opportunity to learn from some of the industry's top professionals.

November 1, 2009

Copyright 2009© LRP Publications