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Workers compensation claims must be aggressively addressed early on

Workers compensation claims must be aggressively addressed early on

Hours before her third-party administrator receives a new workers compensation claim, Laurie Ogsaen telephones employees injured at Evergreen International Aviation Inc. facilities across the United States.

Calling workers immediately after an injury to help them understand what to expect from the workers comp system and who else will be calling them—be it a TPA claims adjuster or a nurse case manager for more serious injuries—is the best practice she knows of to keep injured employees from contacting attorneys, said Evergreen International's workers compensation manager in McMinnville, Ore.

“Since I am in corporate, the first thing I require of (field) managers is to make sure they get the worker medical treatment and advise them of the process, Ms. Ogsaen said. “After they are all done treating and (injured workers) go home, I call them and make the first point of contact with them from corporate, which seems to mean a lot to a lot of them.”

Taking such measures immediately after an injury helps maintain control of claims so they don't evolve into tough-to-resolve cases, experts say.

If employers or their representatives don't aggressively address a claim early in its life cycle, there is greater possibility it will drag out, said Mike Kenitz, Midwest regional practice leader for strategic outcomes practices at Willis North America Inc. in Pittsburgh.

“The bottom line is comp is money and time is money,” Mr. Kenitz said. “The end result is the longer a case is open, the more it's going to cost. The less attention it gets up front, the more time it's going to take (to close) and the more costly it's going to be.”

Employers' early attention to claims, in addition to their insurer or TPA's management, also helps ensure that potential “red flags” warranting additional scrutiny are not overlooked, added Peggy Crook, director of global claims risk management services in McLean, Va., for Hilton Worldwide Inc.

Because employers know their company's culture and work practices, they are more likely than an outside claims adjuster to recognize warning signs that may mean a claim is not compensable or an outright fraud.

For example, Ms. Crook has seen housekeepers claim injuries from flipping hotel bed mattresses. But flipping mattresses is left to a “houseman” and not within the course of a housekeeper's employment.

Therefore, such claims warrant further investigation. But an outside adjuster may not know the subtle distinctions in Hilton job roles and wouldn't scrutinize the claim further, Ms. Crook said.

“It could be a missed opportunity,” to stem an unwarranted claim that would otherwise be challenging to resolve, Ms. Crook said.


Even when claims are legitimately compensable, navigating state workers comp systems is a “daunting process” for hurt employees who may be fearful because they don't understand what will happen next, Ms. Ogsaen said.

When making her first telephone contact with injured employees, she discusses the information a claims adjuster will provide them, such as their claim number and where to go for any additional treatment, Ms. Ogsaen said.

“That way everything is so smooth,” Ms. Ogsaen said. “Knowing that the employer does care and helps them through the process is huge. It can keep a claim from being litigated and the employee being disgruntled.”

The attention doesn't end there.

Workers out on disability get a call from her several times a week to discuss the progress of their medical treatment and their nurse case manager's service level, for example, “just to make sure things are going the way they are supposed to go, because I am in Oregon and a lot of times (the claimants) are in New York or 38 other states,” Ms. Ogsaen said.

Ms. Ogsaen said she obtains TPA adjusting services through insurer C.V. Starr & Co. Inc., which contracts for the services.

Along with helping injured employees navigate the workers comp system, Ms. Ogsaen said her calls to workers help assure that claims adjusters get the information they need.

“We all know that the adjusters have a caseload that probably isn't realistic,” she said. “And if I can smooth the way by providing them every single thing they need,” it helps produce a favorable outcome.

Aside from helping injured employees recover, the telephone contact also helps assure that the claim Evergreen Aviation is funding is not fraudulent, Ms. Ogsaen said.