Cost Containment Program Overview

Why Have One?

Just as the prevention of Workers' Compensation claims are important, keeping the amount of claims to a minimum after it does occur, is also important. A program of following each claim to make sure that the treatments are being followed and that the employee is returned to work as quickly as possible, and that the benefits are provided quickly helps to avoid the need for the employee to seek legal help. Questionable claims that are properly investigated, handled, and reserved by the insurance carrier is critical to the goal of reducing your Workers' Compensation insurance costs.

Assist Injured Employee

Any claim involving or potentially involving lost time should be treated as a serious matter deserving of management attention right from the start. The employee needs reassuring that his/her medical bills will be taken care of and that if he/she is forced to miss work, he/she will receive compensation from the insurance company. Many injured employees seek legal assistance because they do not understand how the system works and are afraid they will receive nothing or will be terminated for filing a claim. Some early intervention by the employee's supervisor can relieve some of this anxiety and smooth the way for a quick return.

Supervise Treatment

We recommend that you contact the medical facility immediately after the employee's initial visit. Determine the extent of the injury, discuss the anticipated schedule of treatment, and inquire about the possibility of a release to limited duties if a full release is not anticipated for a while. Find out the time the next appointment and follow-up to make sure the employee attends. Continue this process until employee is fully released.

Return to Work

It is very important to get the employee back to work as soon as possible even if the job to be performed is of limited value. Sitting at home collecting disability seems to be addictive and the longer an employee is away from work the less interested they seem to be in returning. If you suspect the employee is malingering, there seems to be some value in making the modified work as menial and unappealing as possible so that a return to their former duties looks more appealing in comparison.

Interact with the Claims Administrator

Immediate and constant communication with the claims examiner at the TPA is critical. If you know of information that may assist them in handling the claim such as prior injuries, suspicious circumstances, failure to make doctors appointments, etc., be sure to let them know immediately. In additions it is important to discuss the treatment plans, early return to work options, and to make sure that time and cost estimates are accurate. You should discuss a game plan for closing the claim and then follow up to make sure that it is being followed.

What We Do

All claims administrators can provide regular claims information to their customers. These reports can be produced monthly, quarterly, semi-annually, or annually. If you are not already receiving these reports on a regular basis, we can help get them for you. In addition, we would meet with you several times a year to review the loss information for trends and problems. We will also be following any lost time or open claims to see that they are proceeding properly and are reserved appropriately. We will meet with management or the safety committee to review our findings and to recommend modifications to the safety program as necessary. We will help you to establish modified work programs, early contact programs, treatment supervision programs, and review proper claims reporting procedures including OSHA logs and documentation.

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