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3 things you must know about workers' comp
"People think of insurance as somebody gets hurt, they submit a claim, they get paid, and that's the end of it, but there are all different types of programs," says Christine R. Zichello, RN, COHN-S, CSHM, ARM, FAAOHN, senior risk control specialist at PMA Insurance Group's Mount Laurel, NJ, branch office. Here is what you need to know:
• What type of policy has your organization purchased?
Your company might be on a guaranteed cost plan, a retrospective rating plan, or a large deductible plan. Also, you need to know how funds are allocated for premiums. Is there a chargeback for losses to the department?
"With a high-deductible program, it's your company's money that is paying for the workers' compensation bill up to a set amount for a given accident, as opposed to guaranteed cost programs where the money comes from the insurer," says Zichello.
• What is involved in the overall workers' compensation process?
To learn more, here are recommendations from Moniaree Parker Jones, RN, MSN, COHN-S, CCM, a Birmingham, AL-based legal nurse consultant. Jones also is a former senior occupational health nurse in the Alabama/Mississippi regional office of State Farm Insurance Co. and worked as the sole occupational health nurse at Georgia Gulf Corp., a chemical plant in Plaquemine, LA.
— Attend training given by the National Institute for Occupational Safety and Health. (For more information, go to niosh-erc.org. Click on "Search all courses by topic" and then select Workers' Compensation and submit.)
— Attend local occupational health meetings and the national conference held by the American Association of Occupational Health Nurses. (For more information, go to www.aaohn.org. Under the "Continuing Education" heading, click on "Symposium & Expo.")
— Contact your state workers' compensation office.
• What data are available from your insurer?
Denise Zoe Gillen-Algire, RN, BSN, MBA, COHN-S/CM, FAAOHN, president of the Workers' Compensation Association of New Mexico, says, "If you have never worked for an insurance company, you are not aware of all the data they have available."
Use your workers' compensation carrier or third-party administrator to obtain information on specific and aggregate claims data, such as lost time claims, claims by area and/or department, specific cause of injuries, as well as totals incurred for medical and indemnity, in aggregate as well as by claim.
Many workers' compensation carriers or third-party administrators provide a web portal to their clients. At that portal, you can run numerous reports regarding your claims data and access detailed notes on a given case from the insurance side. Using this information, you can work collaboratively with the adjuster. For example, if you notice that an employee stated that light duty was not available, you can go to the supervisor to confirm if it is, in fact, available, and inform the adjuster on how the company can accommodate the employee.
"This puts you all on the same page," says Gillen-Algire. "You may be aware of additional information to help manage that loss."