One More Time: Managing Claims Cost
by Kirk Lloyd, Risk Management Services, Inc.

The ABC workers’ compensation insurance program with SAIF Corporation provides eligible members with significant cost reduction. Those savings exist only because our group losses have been better than statistical expectations. SAIF helps us to monitor the performance of the group, and there are some interesting trends within the data. The good news is that the rates at which claims occur is going down, suggesting that injury prevention efforts are working. However, the negative trend is a significant increase in average time loss days on the claims that do occur, which of course means that those claims are becoming more costly. With this in mind, we need to again encourage our members to follow the best possible practices in claims management, which will promote recovery and minimize the expenses on those injuries that do occur. Those practices include the following:

• Report claims to SAIF right away, and communicate early and often with your claims adjusters and return-to-work consultant during the process.
• Perform an internal accident analysis to determine what can be learned for future prevention efforts and to identify any “red flags” for fraud or misrepresentation.
• Minimize time loss days by having a proactive Return-to-Work (RTW) program in place and ready to use when needed.

Claims management and RTW can get a little complicated, and we really don’t want any of our members to have so many claims that they get a lot of practice at this! There is great information and sample forms available in the “employer” section on the SAIF website www.saif.com. But rules change and circumstances vary, so the best approach is to partner with your SAIF return-to-work specialist on a case-by-case basis. You can call SAIF Corporation at 1-800-285-8525 to be connected with the RTW consultant assigned to your policy.

It’s helpful to keep “Release to Return to Work” forms with your blank claim form 801’s in the event that an injury does occur. The “Release to Return to Work” form should go to the medical provider along with the injured worker, as this form will be used to obtain work release information from the physician. If a temporary modified job will be needed during recovery, this form will help determine what sort of job duties would be appropriate. Ongoing communication with your injured employee is a must during this process. If there are concerns regarding the modified work identified, use a “Modified Job Description” form to seek approval of the job from the attending physician. Once the employer and physician have come together on a modified job, the employer may need to offer the temporary modified job through a very specific process. Your RTW consultant can assist you throughout this process. We know it may require a little extra creativity to come up with a job that makes sense for both the employer and the injured worker, but this process is a powerful tool to manage cost and promote recovery so we strongly encourage our members to participate whenever possible.