July 2013 Newsletter

Our Commitment to Our Members: 10 Most Important Elements of Claims Management

Downey10List3Workers compensation is a fact of life for business, and it is not always the easiest thing to negotiate. Here are 10 ways we help you manage the process.

  1. It takes all members of the "team" to produce the most favorable claim outcome possible. Commitment of the injured worker, employer, physician and claims examiner is essential in bringing each claim to resolution in a timely, positive manner. We are committed to keeping the lines of communication open to facilitate this team approach.
  2. We investigate all claims for compensability and strive to handle legitimate claims in a timely and efficient manner. Most claims can be deemed compensable within the first 24-48 hours. Once a claim is deemed compensable, we will move forward with direction of medical care as quickly as possible.
  3. For the few claims that aren't quickly deemed compensable, we will conduct a thorough, timely investigation. While we will pay for all compensable claims, we certainly don't want to cover medical conditions or injuries that are not work-related. Obtaining recorded statements from the injured worker and witnesses is crucial in the investigation process. It is important to have an accurate understanding of how the injury occurred and the extent of the injury. We will also request records from family physicians and any pertinent prior-treating physician. We rely on our members to notify us of any red flags or suspicious activity.
  4. We explain available benefits to injured workers. Although there are exceptions, most injured workers are unfamiliar with the workers compensation process. Explaining all available benefits upfront will avoid headaches as the claim progresses. Our claims examiners know it's important to explain how disability payments are calculated and when they will be paid. Injured workers should know if they are entitled to mileage reimbursement or what they should do if they get billed directly for treatment.
  5. We pay benefits in a timely manner. Many injured workers live paycheck to paycheck. Worrying about when their disability check will arrive causes undue stress and could result in a litigated claim. We communicate with our members when we need wage information so disability checks can be issued on time.
  6. We direct medical care. Indiana is one of the few states that allow direction of medical care--this is a key component of the claims-handling process. Referring injured workers to quality physicians, with expertise in handling workers compensation, benefits everyone involved in the claim. Obtaining an accurate diagnosis quickly enables an appropriate treatment plan to be implemented, which translates to a positive outcome on the claim. This is a win-win for the employer and the injured worker.
  7. Case management can be a useful tool when managing a difficult claim. Whether the injury is severe, you have a difficult injured worker, or both, using Nurse Case Managers (NCM) can effectively assist in resolving the claim. NCM serve as liaisons between the injured worker, the physician, the employer and the claims examiner. They often expedite the treatment process by asking questions and confirming treatment plans at the time of the appointment. NCM also assist in scheduling follow-ups, diagnostic testing, surgeries, etc., in a timely manner.
  8. We choose our resources wisely. Utilizing knowledgeable and ethical physicians, NCM and attorneys is essential. Obtaining input from all or any of these resources facilitates optimal resolution of the claim.
  9. We utilize cost-containment networks when possible. Physical therapy, pharmacy and diagnostic networks enable us to provide quality care and services at substantially reduced rates. We also use bill review services to scrutinize invoices for accuracy and reasonableness of charges, as well as to apply any PPO discounts applicable.
  10. We provide our examiners with the appropriate tools to facilitate the claims-handling process. Seminars and training sessions educate our examiners on medical procedures as well as current legal issues and case law updates. We believe ongoing education is crucial to examiner development. We encourage our examiners to obtain AIC and CPCU designations, as well as other certifications pertinent to insurance and claims handling.

 

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Call Us for Work Comp 101 Training

Downey Info4You've probably noticed the biggest challenge in claims management is making sure all parties understand what's happening and the role they play in the claims process. Communication is key. Can you readily answer these questions?

  • Do you have a designated workers compensation physician?
  • What about a light duty program?
  • Do your department heads know what to do and whom to notify when an injury occurs?
  • Do your employees understand what's required of them when an injury occurs?

For assistance with any questions or topics related to workers compensation, we offer educational Work Comp 101 sessions. We tailor the sessions to each individual member. Our claims personnel will come to your location to provide an informal one-on-one session with those managing claims or a formal presentation for all employees. Let us know what you need, and we'll work with you to customize the information we provide during the training. For more information, please contact Claims Manager Lisa Napier Mohler at 765-252-3036 or email lmohler@downeypublicrisk.com.

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OSHA Workshop

The OSHA Outreach Training Program for General Industry is an excellent resource for teaching General Industry workers about their rights, employer responsibilities, and how to file a complaint - as well as how to identify, abate, avoid and prevent job related hazards.

The workshop lasts 10 hours (1.5 days) with 9 hours of prescribed courses and 1 hour of electives. Training covers a variety of General Industry safety and health hazards which workers may encounter, and emphasizes hazard identification, avoidance, control and prevention. There is a $5 per person charge for the credentials.

Learning objectives on a number of these topics are on the CD which is distributed in all OSHA General Industry trainer classes, and is available for download at the Outreach Training Program website.

To learn more or to register, please call Judy McQuilling at 800-382-8837.

Topics are as follows:

  1. Mandatory - 9 hours
    1. Introduction to OSHA - 2 hours
      1. OSHA has required training content for this module - see www.osha.gov/dte/outreach/construction_generalindustry/teachingaids.html.
      2. Covers workers' rights, employer responsibilities and how to file a complaint. It includes helpful worker safety and health resources. It also provides samples of a weekly fatality and catastrophe report, material data safety sheet and the OSHA Log of Work-Related Injuries and Illnesses.
      3. Materials include an Instructor Guide, PowerPoint slides, student handouts, and participatory activities.
    2. Walking and Working Surfaces, Including Fall Protection - 1 hour
    3. Exit Routes, Emergency Action Plans, Fire Prevention Plans, and Fire Protection - 1 hour
    4. Electrical - 1 hour
    5. Personal Protective Equipment - 1 hour
    6. Hazard Communication - 1 hour
    7. Ergonomics/Lifting Safety - 1 hour
    8. Bloodborne Pathogens - 1 hour
  2. Elective/Optional - 1 hour: Must present at least two hours of training on the following topics. At least two topics must be presented. The minimum length of any topic is 1 half-hour.
    1. Hazardous Materials
    2. Materials Handling
    3. Machine Guarding
    4. Introduction to Industrial Hygiene
    5. Safety and Health Program
    6. Fall Protection
    7. Teach other General Industry hazards or policies and/or expand on the mandatory or elective topics

IPEP course work consists of these 9 courses plus 1 optional course selected by participant; optional course subject to approval by OSHA.

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Protecting Emergency Drivers Through Simulator Training

simulator2Preliminary figures released by the FBI indicate there were 93 law enforcement officers killed nationwide in the line of duty in 2012. Forty-six of those officers were killed in the line of duty in motor vehicle crashes, including pursuit driving, traffic stops or emergency responses. Fire department crashes during emergency responses, while less frequent or deadly, also result in millions of dollars in losses each year.

How can drivers practice negotiating these dangerous situations successfully?

One way is through simulator training, provided free of charge by IPEP to its members. The training sessions are conducted throughout Indiana with the aid of the Doron Emergency Driving Simulator. The simulator is self-contained in a 35' trailer and is transported to the training site, normally the parking lot of a police department, sheriff's department or fire department.

Training days are usually held Tuesday, Wednesday and Thursday from 8 a.m. to 6 p.m. and are divided into five two-hour training sessions consisting of two students each. With this schedule, 10 officers can be trained per day, or 30 in a training week. The training consists of operating a simulated police car/fire truck or ambulance in computer-generated simulations of emergency responses to various scenarios.

If you feel your department would benefit from this training, feel free to contact Tom Clarkson at (260) 336-2732 or tclarkson@downeypublicrisk.com. He is currently concentrating on the southwestern quadrant of Indiana, but he will work with you on scheduling a visit to your area.

 

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Save the Date!

Downey Info2SAVE THE DATE!

2013 IPEP Annual Safety Seminar

We will be coming to a location near you in mid-October to offer this FREE half-day event. We'll cover important topics like bloodborne pathogens, snowplowing safety and distracted driving. Mark your calendar now, and we will send more details in August when registration opens.

Oct. 10 - Noblesville

Oct. 11 - Columbus

Oct. 15 - Huntingburg

Oct. 16 - Danville

Oct. 17 - Auburn

Oct. 18 - Plymouth

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Claims Department Contact List

Toll Free Number: 800-382-8837

Submitting First Reports
Email: ipepclaims@downeypublicrisk.com
Fax: 765-868-3310

Lisa Napier Mohler
Claims Manager
765-252-3036
lmohler@downeypublicrisk.com

Craig Barnhart
Senior Claims Examiner
765-252-3031
cbarnhart@downeypublicrisk.com

Denis Boland
Subrogation Specialist
765-252-3033
dboland@downeypublicrisk.com

Rae Butler
Senior Claims Examiner
765-252-3030
rbutler@downeypublicrisk.com

Peggy Hemming
Claims Examiner
765-252-3034
phemming@downeypublicrisk.com

Gayle Deford
Administrative Assistant
765-252-3029
gdeford@downeypublicrisk.com

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