| Winter 2006
New Claim Teams Help Cut Costs
By Lisa Corless
Senior Vice President, Claim & Information Services
During my 17 years in the insurance industry, I've learned two keys to helping employees meet their potential: 1) Identify their strengths; 2) Put them in positions where they can use their strengths to serve your customers better.
With that in mind, Texas Mutual Insurance Company put its claim staff to the test. Every adjuster underwent a thorough skills analysis. The result is two new teams designed to save our policyholders money by resolving claims more efficiently. The process starts when you report an injury.
Our compensability determination unit (CDU) goes to work within 24 hours of receipt of an injury report. If necessary, adjusters take a recorded statement from the employer, injured worker and witnesses. They may also send a field adjuster to the injury site to take photos, conduct interviews and find out how the accident happened. The team's goal is to determine whether the injury is compensable as soon as possible.
Timely accident investigation became even more crucial last summer when the Texas Legislature passed House Bill 7. The bill allows insurance carriers to establish or contract with workers' comp health care networks. It also requires that in some instances, insurance carriers pay up to the first $7,000 in medical care on an in-network claim, even if they ultimately determine that it is not compensable.
That means that the quicker we determine compensability, especially on in-network claims, the better it is for us and the employer. Most claims are legitimate; our priority is to help the injured worker get back on the job.
That's where the new return-to-work team comes in. The team is made up of adjusters who specialize in helping injured workers get the care they need to recover and return as productive members of the workforce in a timely manner. Studies show that injured employees who go back to work recover faster. Return-to-work also minimizes the effects of paying overtime, hiring extra help and other costs associated with workplace accidents.
The team contacts injured workers, health care providers and employers to identify return-to-work opportunities early in the claim. It regularly reviews injured employees' status until they go back to work under modified or full duty. If injured workers need extra help, the team refers the claim to a case manager.
Both teams count on employers to participate in the process.
Employers can help the return-to-work team by providing modified-duty assignments that meet injured employees' work restrictions. They can help the CDU team by providing access to injured workers, accident witnesses, the accident scene and any other information important to the investigation.
We know this takes time away from the day-to-day affairs of running a business. We're asking employers to keep the end goal in mind. This new claim structure can get injured workers the care they need and help save money. Ultimately, that's what is best for everyone involved.
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