Early Intervention will save your firm many of the costs associated with workers' compensation claims that “fall through the cracks.”  Early intervention on all new claims has proven to have a positive impact on the length of disability and ultimately, claim payout.  A proactive course of action preserves investigative facts that can affect compensability and/or offset opportunities.  Early intervention also enhances our ability to provide appropriate medical management. 

Checklist for Handling Claims

The initial period is defined by C & I Safety as the first four days of any claim. The initial period is critical in handling workers’ compensation claims. This is not an exclusive or inclusive list. Be sure to:

Immediately

• Obtain first aid or medical services
• Have someone accompany the injured worker to a selected medical provider (preferable but the employee has the final choice)
• Report incident/ accident within
• Notify family if applicable
• Assign a responsible person to follow the claim
• Document the area’s condition

First day (Responsible person to follow claim)

• Report to claim handler outside the company (insurance company or third-party administrator)
• File a State of WI First Report of Injury (WKC12)
• Obtain initial Medical Report and Duty Status Report
• Determine, on a preliminary basis, whether the injury is covered by workers’ compensation
• Refer the case to insurance company or third-party administrator for investigation
• Determine the type of claim
       - Medical Only
       - Restricted or Transfer
       - Lost Work Days or Days Away from Work
• Review the supervisor’s report for an initial determination regarding the necessity of an investigation
• Follow up with the employee

First four days (Responsible person to follow claim)

• Talk to insurance company or third-party administrator
• Talk to treating physician about Medical Report and Duty Status Report if applicable
• Talk to treating physician to learn diagnosis and treatment plan
• Evaluate whether medical rehabilitation is necessary or appropriate
• Develop return-to-work plan
• Forward all correspondence to insurance company or third-party administrator
• Follow up with the employee
• Responsible person to follow claim

Ongoing (Responsible person to follow claim)

• Talk to insurance company or third-party administrator
• Talk to the treating physician about the Medical Report and Duty Status Report if applicable
• Forward all correspondence to the insurance company or third-party administrator
• Follow up with the employee
• Continually reevaluate the treatment plan based on the new medical information
• Update the return-to-work plan
• Refer for vocational rehabilitation
• Refer for pain management evaluation of chronic pain, if appropriate
• Maintain contact with the injured employee
• Use a “wellness” approach to continue to reinforce the company’s concern
• Consider a medical examination by an independent physician (IME), if warranted