By Donna Motley, Director of Claims

Medical expenses always seem to be on the rise. The Workers’ Compensation weekly benefit (the amount paid to the injured worker) usually increases annually even though it is based on the State Average Weekly Wage. Workers’ Compensation coverage is mandatory in the State of Michigan – part of the cost of doing business!

Once a Workers’ Compensation claim is turned in to our office, we take the reins and take control, attempting to minimize all the costs involved, the length of disability, and to assure a successful return of the injured worker to productivity. Everyone benefits. But, as an employer, there are things that you can do to help mitigate the expenses or costs on the claim.

Obviously, one of the most important things an employer can do, is report the claim As Soon As Possible! That way, we are controlling treatment (and costs) from the onset. As an employer, NEVER tell an injured worker to seek treatment with their primary care physician or a physician of their choosing. Any treatment outside the Occupational Clinic results in a delay in obtaining medical records that are required before authorization to treat can be rendered. If an employee is off work during this period – the cost of the claim has just increased significantly. If the injury is questionable and/or you are unsure of the direction that should be taken, PLEASE call our office for advice.

It is not uncommon for us to assign a Nurse Case Manager to a claim. A Nurse is assigned to assure the injured worker is receiving appropriate medical care, to assist the treating physician in expediting required authorizations for testing and/ or treatment, and to provide our department with the required medical status so treatment and/ or wage loss benefits to the employee are not interrupted. Any interruption of this process results in a longer recovery time for the injured worker. Longer disability or treatment means a higher dollar reserve on the claim.

When employees “forget” about their doctor’s appointment or “miss” a therapy appointment, treatment and recovery are also delayed. Employees have been known to cancel their doctor’s appointment without letting either the Nurse Case Manager or the Adjuster know. So when the Nurse Case Manager shows up for the appointment and waits for 45 minutes to 1 hour for the injured worker to show and/or call, we are being billed for the Nurse’s time and expenses. On a recent case of mine, the injured worker alleges he wrote down the wrong time of the appointment. The Nurse showed for the appointment and waited until she finally got ahold of the injured worker and the appointment was ultimately scheduled for another date. In that instance, we had to pay for the Nurse’s travel time, wait time, mileage, phone calls and for the time it took her to write her report – which totaled $342.68 – for nothing. So that claim now has an added expense that could have been easily avoided. Not to mention, most doctor’s offices charge for a missed appointment. (And that was just one missed appointment. You can see how expensive this can be when multiple appointments are missed.)

As employers, you should be in touch with an injured worker during their recovery period. Please impress upon your employees, the importance of their cooperation in the claim process. I am aware that some employees think the goal of a Workers’ Compensation carrier is to deny benefits – and I think as an employer you know that is not true. No one benefits when a claim is unjustly denied. It is sometimes amazing how smoothly and quickly an injured worker will recover when the rules and procedures are followed. In Workers’ Compensation cases – time equals money.