How can I get my Workers’ Comp claims closed?
Q. There seems to be so many delays in moving a claim to resolution and closure. What can an employer do to speed up the process?
A. Talk to your employee about his treatment and recovery. “How are you feeling?’ “Are you getting better?” “Is there anything I can do to help you?” are legitimate questions to ask. Showing concern for your employee’s recovery helps to reduce your employee’s fears.
Communicate with the claim’s adjuster assigned to each claim. Ask them to send you a written claim status report and action plan with target dates for resolution. Follow up with the adjusters frequently and let them know you want to be informed of the progress of each claim. Let them know that you are an interested participant.
Insist on work restrictions from the doctor. If the doctor says TTD or Totally Temporarily Disabled, provide additional information for the doctor to consider. Discuss with your employee what modified or alternative duties you can provided during his recovery. Ask him to discuss these options with his doctor.
Q. My employee has had the same work restrictions for 3 months with no sign of improvement.
A. Keep talking to your employee. Ask him if he is improving? If not, has he discussed treatment options with his doctor? Would he like to have a nurse case manager assigned to help him with discussing options with the doctor? He can discuss his concerns with his claim’s adjuster, too.
Meanwhile, if there is no cooperation from the doctor, ask the claim’s adjuster to object to the treating doctor and request a QME, Qualified Medical Examiner, for an opinion of treatment.
Keeping your employees at work with continuous discussions about their well-being will help to solve problems or concerns as they arise.
Q. When does a claim finally close?
A. The employee’s medical condition and treatment must reach recovery or a plateau, called Maximum Medical Improvement (MMI). MMI is a medical-legal term that ends Temporary Disability benefits and moves the case to the final stages. At that time, three options may be presented:
Discharged from care; full duty release; no future treatment: Claim Closes
Full duty release; no permanent disability, but a need for future medical treatment: A Stipulated Award must be signed by the employee and approved by the Workers’ Compensation Appeals Board (WCAB). The claim remains open for the lifetime medical award needed for this injury.
A level of permanent impairment, called Permanent Disability (PD), and there may or may not need future treatment. There may or may not be permanent work restrictions that require accommodation. If the PD is resolved by a Stipulated Award, the claim remains open for payment of the Award ( at $290/ week until the full Award is paid) and future medical care; or if it is resolved by Compromise and Release (C&R), the file is closed. Both documents must be signed by the employee and approved by the WCAB.
The employer’s engagement with the injured employee and involvement throughout the life of the claim will keep the claim moving and resolved with the most optimal results.
If you need assistance along the way with obstacles that arise, contact an ESM Advocate to discuss the options.