OK, an employee injury has occurred and a claim has been submitted to the insurance company. This is typically where everything disappears into a thick fog.
From the time that the claim is reported to the insurance company until their next experience modification is published, most employers have little ability to monitor and measure how effectively a claim is being managed.
While most insurance companies mean well, the reality is that their claim examiners are often overworked or lack the necessary experience/motivation to resolve a claims in manner that is fast, firm and fair to the injured employee. Too often, injured employees become frustrated with the “system” and retain an attorney to help them negotiate all they can get in the form of rehabilitation and temporary/permanent disability awards.
Through the use of its own staff and retained claim specialists, Risk Concepts will work directly with the insurance company’s claim examiners to ensure that the claim strategy properly reflects the employee’s medical condition and physical limitations. Once the proper diagnosis and treatment course has been determined, Risk Concepts continues its communication to ensure that the claim move towards closure and that all outstanding reserves are appropriate.
Ideally when a claim occurs, the employee remains in touch with the injured employee to maintain goodwill and encourage the employee to return to work as soon as possible. When the employee can not return to work (or does not want to come back), the claim can often take a turn for the worst and costs increase dramatically.
For example, the average cost of a “medical-only” claim (no lost time) is $870. When an employee misses time and is given temporary disability benefits, the average claim cost increases to $11,761. When the disability worsens from temporary to permanent, the average claim costs increase to $38,390 and $140,680 for a “major” permanent disability.