December 16, 2009

Top Thirteen (huh?)
Claim/File Handling
Boo-Boos

By Kevin L. Connors

With apologies to David Letterman, we offer you, sans flashcard format, the top claim/file handling boo-boos to avoid, either in maintenance of claim sanity or in preservation of job security.

13.

Choosing medical provider panels based on causal references, other than certifications, specialties, reputation, and locations proximate to employer location.

12.

Not recognizing the critical claim importance of a defense medical examination, in terms of matching specific injuries with properly-credentialed medical specialists, and making sure that medical examiners clearly understand the injuries being claimed, the alleged mechanism of injury, what injuries the carrier believes are legitimate/illegitimate, and insuring that the medical examiner has all of the diagnostic studies, preferably of high resolution film quality, and all medical records revealing history, complaints, and clinical findings, to properly authenticate the defense medical examination process.

11.

Missing the 90-day deadline on stopping temporary compensation.

10.

Not securing complete pre-injury medical and employment files on the Claimant, either through authorization or through subpoena power during litigation.

9.

Not routinely issuing Notice of Ability to Return to work forms, whenever new medical records/reports indicate work capacities, no matter how trivial.

8.

Not using a Notice of Ability to Return to Work, before offering a return-to-work job to the injured worker.

7.

Not running claims index checks on Claimants reporting injuries or seeking compensation benefits, to secure their claims history, and pre-injury medical information.

6.

Not utilizing Act 57 forms, to require periodic Claimant reporting of wages, benefits, and change in physical condition.

5.

Not sending the file to DuffyConnors to defend/resolve.

4.

Using generic medical terminology on Bureau forms to describe reported/accepted injuries, without tying generic medical terminology to specific body parts, potentially converting “sprain/strain” into whatever injury the Claimant decides that he/she likes best, years later, in the Review Petition phase of the claim.

3.

Using generic body parts, like back, head, etc., on Bureau forms, for the reported injury.

2.

Accepting the claim because the Claimant said it must be workers’ compensation!

1.

Issuing NCP for the Monday morning report of “you know, I think I got hurt last Friday, just before I clocked out”.

Channeling interactive client ideation on their favorite bone-headed claim-file handling errors, and casting a wide net to include “you can’t win that claim before that judge” defense counsel, we invite, encourage, nay, double dare, positive and/or negative feedback on our list, allowing for the momentary distraction of reflecting on an imperfect practice and system made more perfect with a mirror and a smile.

Questions concerning the practical implications of the day-to-day administration of workers’ compensation claims should be directed to our Workers’ Compensation Department.

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