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Worker’s Comp And Disability Claims

By: Paula Allen

Companies can better manage their workers’ compensation and disability claims by having resources to handle these claims better. Paula Allen, of FGI, looks at how employers can achieve this and save money.

Every smart business looks for ways to save money. One often overlooked way is to examine how workers’ compensation and other disability claims are handled. This is an area with a tremendous opportunity for savings. It’s also an area fraught with frustration, cost, and delay to both employer and employee if not managed effectively.

So how can a company better manage its workers’ compensation and disability claims? The answer is to establish an infrastructure that monitors and intervenes at all levels of a workers’ compensation board and an Employee Assistance Program (EAP) system that picks up when the WCB leaves off.

This doesn’t mean that a business must have a specific department or person to mirror every division of a workers’ compensation board. What it means is that a business needs resources, internal or external, to capitalize on opportunities, correct errors, and hold the system accountable.

Workers’ compensation boards are set up to deal with:

How your organization deals with each of these will play a role in what kind of experience, and what kind of financial consequences, your company will face. A company can save time and money by having a person or group who understands all aspects of workers’ compensation monitoring the process on their behalf.

When can you expect to encounter problems with workers comp?

All sides would agree that in straightforward cases, or cases involving catastrophic injury, workers’ compensation boards act effectively and comprehensively. This is not always true with cases that have some sort of complication and fall in between these two extremes. Complicated cases generally fall into three categories.

Difficulty Coping

The first occurs when a seemingly simple recovery becomes more difficult. In such a situation, having a health professional work on your behalf to follow up with the board’s nurse case management system can ensure that your employee’s needs are front and foremost.

The second situation occurs when a personal concern, a long-standing mental issue, or a physical problem where an individual has difficulty coping adversely affects even the best-laid plans to return the employee to work.

From a compensation board’s perspective, such issues are likely non-compensable and, therefore, not their concern. But for employers, it is a concern, causing problems for managers, compensation administrators, and the organization’s productivity.

To ensure the best outcomes for situations where there is a personal or mental health concern, a company needs:

The third situation occurs when there is a problem with the way an employee relates to the workplace or vice versa.

The problem could be due to changes in the workplace, conflict, or performance issues before the injury as well as a history of failed return to work attempts or a history of accidents. These situations require joint problem solving – not mediation that is built into the compensation system when an issue is in dispute. There must be a way of addressing this concern before it becomes a dispute.

Formal joint problem-solving needs to be part of any disability management system. It doesn’t make sense to identify a case as one that’s likely to cause problems and then ignore the situation and allow those problems to occur. Acompany is simply left with an employee relations nightmare that wastes time and money.

Structured joint problem-solving provides a forum that can resolve the most emotionally- charged situation.

This type of problem-solving works best when it’s impartial, so it’s preferable to bring in a third party to facilitate the process. The perception of impartiality allows the employee to speak freely and openly and ask the kind of questions that might not be well-received by someone from within the workplace.

Integrated Approach

An examination of how your company deals with complicated workers’ compensation cases should lead you to consider the efficiency of your disability management system. The most important factor for reducing costs and increasing efficiency is having an integrated approach. This means having the same system deal with all types of disability absence both occupational (Workers’ Compensation related) and nonoccupational (extended sick leave and short-term disability) and having alignment with all payment systems. In addition, it’s important not to differentiate in the quality and substance of how you manage work-related and non-work related injury and illness.

There are two options to ensure this is the case. If work-related and non-workrelated issues are managed separately, make sure the management of both are aligned. Or have a single system that varies only as required administratively. For most, the single system is easier to set up and manage and, ultimately, makes more sense.

So where do you start? Here are some basic suggestions:

The bottom line is that taking the time upfront to follow a critical checklist about how workers’ compensation and other disability cases will be managed can put your organization in a stronger position to make decisions that will save time, money, and frustration. It’s a win-win situation for all concerned.

Paula Allen is business leader, disability management, for FGI.

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