Managing Catastrophic Workers’ Compensation Injuries in Partnership with a TPA

After receiving a call that an employee has been involved in a catastrophic accident, the next steps taken are critical to the outcome of how the claim develops and can ultimately impact the lifetime cost.  Outlined below are important steps an employer can take in partnership with a Third Party Administrator to work toward a more positive outcome.

1. Establish the facts

   It is critical to establish the facts of the incident, such as employee demographics, type of injury sustained, location of the accident, how the incident occurred, witnesses, and where medical treatment is being administered, as soon as possible

2. Designate a primary point of contact

   Designate the appropriate individual who is best suited to be the primary point of contact to establish early communication and rapport with the employee as well as the employee’s family. The designee, such as a supervisor or a human resource representative, should be present at the medical facility where initial treatment of the employee is taking place to represent the company in providing support and contact information to the claimant, their family, and the medical facility, until a claim has been established with the third party administrator.

3. Assign a claims adjuster for consistent messaging

   Immediate communication from an assigned claims adjuster to all parties involved can eliminate an employee’s concerns about recovery and help assure the injured worker of the benefits/medical care that they are entitled to by answering questions about their claim. This will help reassure the employee that they will be taken care of and prevent any misunderstandings that may lead to litigation.  Once an attorney is involved, communication is typically restricted, creating barriers for case management with both the claims adjuster as well as the nurse case manager.

4. Appoint a qualified nurse case manager

   The claims adjuster should immediately obtain a qualified nurse case manager with expertise in managing the type of injury the employee sustained. This will help ensure appropriate medical care is obtained and address ongoing follow-up care.  The earlier a nurse case manager is engaged in the file, the better chances of successful injury management.  The nurse case manager can provide assessment and early intervention on any complications, as well as possess the knowledge to obtain critical medical information.  This will help assure that needed medical care is not delayed and can be communicated to the pertinent parties in a timely fashion, removing barriers to recovery.

5. Establish and maintain ongoing communication

   Maintaining communication with your employee and third party administrator on work status will help facilitate the potential for return-to-work options. This provides a clear path of communication and expresses the employer’s interest in the well-being of their employees, as well as restoring them to their work environment.

Having a well-defined documented plan in place that outlines the early stages of a claim and  is communicated to your claims management team and Third Party Administrator can help you better manage the ultimate outcome of a catastrophic claim in partnership with your expert team.