1st 90 Days Can Get Injured Worker Life (Pension)

Tuesday, January 15, 2002 | 0

The claims representative's actions during the first 90 days are so critical that errors in judgment can stay with you for the life of the applicant's workers' compensation case. Oftentimes, a delay in gathering information and facts at the inception of the claim can lead to increased costs in administering the file.

The best time to answer any questions regarding a file is within the first 90 days, where the information is still fresh in the minds of all witnesses and the employer. The three-point contact (contact with the employer, the injured worker and the doctor) gets you the critical information needed to setting the path that the case is to take.

Your actions during this time help to establish whether the carrier should admit or deny the case. During this time you will identify subrogation potential on the file, mechanics of the injury in comparison to the diagnosis, treatment plan, etc. Also, you will gather information that will reveal whether red flags are present to warrant further investigation for fraud and referral to your company's Special Investigation Unit.

You're not finding out facts for just your company. You're finding out facts that can possibly be needed or used by the workers' compensation judge. Re-insurers may have need of the information later. Indexing organizations will benefit from your timely action during these first 90 days. A Civil Judge and Jury may find themselves using the information you've acquired during this period, if subrogation is pursued. Did I mention potential audits in the future by the insured, the insurance agent, risk managers, your immediate supervisor, your immediate manager, re-insurers, lawyers, and State Auditors? With all this '20-20 hindsight', many, many other people today will closely scrutinize your actions in the future! Covering all the bases in a timely manner during the first 90 days of a file is the best way to avoid those mistakes that will haunt you in the future.

The next article will review who needs this important