Reducing workers compensation claims severity among injured Prince William County, Va., employees didn't happen by accident.

The county's risk management division actively manages claims through constant contact with injured workers, screening treating physicians and training department supervisors on reporting accident injuries.

As a result, the lost workday incident rate per 100 county employees has dropped from 4.84 in 2004 to 1.5 in 2012, said Lori J. Gray, the county's risk management division chief. For 2012, the county's total workers comp claims severity decreased to $1.45 million from a four-year average of $2.65 million.

Before the county hired Ms. Gray in 1999, department supervisors reported worker injuries directly to a third-party administrator.

But Ms. Gray changed that practice. Now, department supervisors report injuries first to Ms. Gray's claims staff, which works closely with the county's TPA to manage cases as long as they remain open.

“From day one ... we are continuously involved,” said Johnnie Winslow, the division's claims manager. “For example, if we have an employee with an injury severe enough for surgery, we are involved in the entire process and what happens day to day.”

That means staying in contact with claimants and being a liaison for TPA employees, such as nurse case managers. The county contracts with Blue Bell, Pa.-based Pennsylvania Manufacturers' Association Insurance Co. for TPA services and has real-time access to case files so Ms. Winslow can review TPA staff notes as soon as they are entered.

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Requiring county department supervisors to report to the risk management division first provides several advantages that include allowing immediate contact with injured employees.

“It creates a great deal of trust (among injured employees) and helps them realize our focus is their well-being,” said David Wenzel, the risk management division's health and safety manager. “So there are benefits to having claims come in-house first.”

Injury prevention through coordination with safety staff is one of those benefits, Mr. Wenzel said. If the risk management division notices an increase in injuries in a certain area, for example, the division's safety personnel can immediately conduct a site inspection to suggest improvements before more accidents occur.

The process also assures that as soon as recovering employees are medically capable, they are assigned to modified-duty roles, Ms. Gray said.

Reporting claims first to an in-house risk management department rather than routing them directly to a TPA is considered a best practice, said Michael MacAulay, vice president of sales in Mount Laurel Township, N.J., for PMA Management Corp.

In-house risk management staff “are the eyes and ears of the county employee base” and know more about a claimant's work role than the TPA does, Mr. MacAulay said. That means the in-house staff can glean valuable information to help determine whether a claim is compensable or whether further investigation is necessary.

To aid that process, the risk management division trains department supervisors on how the workers comp system works and on the procedures to follow when worker injuries occur, Ms. Winslow said.

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Reducing claims severity also means selecting the right doctors to treat injured workers, Ms. Gray said.

Under Virginia law, an employer can direct employees to specific doctors but must give the worker a choice among at least three medical providers.

Before selecting the doctors allowed to treat county workers, the risk management division's staff meets with them. Those medical providers not committed to helping injured workers improve and return to the job need not apply.

But to help selected doctors understand the duties they will be returning workers to, the risk management division periodically invites the physicians to the county's facilities to see the types of jobs workers must perform and the equipment workers must operate.

The risk management division also hosts breakfasts for the doctors so they can meet the nurse case managers, county attorneys, claims administrators and others managing the county's claims.