Getting the Best Outcome from a Workers’ Comp Incident

The definition of what is the best outcome has become more expansive in recent years. First, let’s define what we mean by best outcome. It’s where the injured employee’s discomfort is minimized, recovery is maximized, and the well-being of both the firm and employee suffer as little as possible. In the past, the employer’s focus has often been primarily on minimizing cost and settling the claim as quickly and economically as possible. But in recent years, the focus has shifted in a more holistic direction toward the well-being of the employee. In addition to creating a more positive work environment, the employer benefits from reduced litigation costs and a more productive workforce because employees return to being productive members of the firm sooner.

The first step in the process is making sure injured employees get help immediately with a quick evaluation of the injury. They also need answers to their questions, and most importantly, compassion. An empathetic representative of the employer, such as a registered nurse, should set the tone by making sure that not only does the injury get promptly attended to but also help the employee manage the paperwork and gain access to additional resources that may be necessary to ensure the employee’s full recovery. It’s important to be prepared to answer questions about job security, how the injured employee will get paid, how long they can expect recovery to take and so on in a caring, compassionate way.

Some of the other people with resources, capabilities and responsibilities who may be important in making the claims outcome more positive for everyone include:

Nurse Case Managers
• To monitor and guide occupational injury care
• To provide guidelines for managing effective treatment utilization.
• To act as a patient advocate
• To provide a non-threatening, friendly, professional relationship with the injured employee. Such support can identify and deal with any personal concerns and help reduce the risk of litigation. It can also help minimize any barriers to returning the injured employee to work, such as childcare issues or financial worries. These are all concerns that may impact the outcome.

Vocational Specialists
• To provide return to work strategies that fit the injured worker’s individual claim circumstances.
• To help employees who have restrictions in their ability to perform work by setting up modified duty for them.
• To intervene when providers are not following sound guidelines related to returning to work.

Surgery Nurse Services
• To help injured employees facing surgery be better prepared physically and mentally, including instilling in them the confidence to achieve a faster recovery. This innovative approach is designed to focus specifically on the needs of patients dealing with surgery, which has historically been a significant driver of high-cost claims.

Physician Advisors
• To ensure that the appropriate treatments are provided based on the injury
• To support other key decisions regarding treatments, procedures, and other facets of injury management that can significantly impact a claim.
• To enhance the utilization review process,
• To provide medical and pharmaceutical expertise to ensure clients and their injured employees continue on the right path to achieve the best possible outcomes.

Prescription Drug Management Advisors
• To help control the use of narcotics, opioids and other appropriate drugs prescribed to treat work-related injuries. This role, regardless of who performs it, is especially important because of the growing concern over misuse of pain medications.

Many if not all of these people and the functions they perform may be critical in getting the best outcome in a workers’ comp incident. But it all starts with an empathetic listener to set the stage with the injured worker in a way that is comforting, positive and reflects the goodwill of the employer.

Please contact the insurance professionals of EPIC’s CRA ProRental Insurance Program at 800.234.6363 if you have questions about how to improve your workers’ compensation incidents claims handling.