Claims Triage and Its Role in Reducing Workers' Compensation
The National Counsel of Compensation Insurance (NCCI) moved towards a new split point in 2013 that increased the number of claims that qualify for impacting the frequency element of your experience mod. As a result, it's critical that employers leverage the appropriate risk management strategies to control their workers' compensation claims.
Managing Workers Compensation with Claims Triage
The goal of claims triage is to provide the appropriate level of evaluation and treatment at the first point of an injury. Multiple studies have shown that addressing a workplace injury on the first day significantly reduces both the recovery time, as well as the costs involved. Often times, an initial injury requires nothing more than rest and self-care with over the counter medicine deterring from an actual workers compensation claim.
Traditional claims triage consisted of employers having on-site medical staff available to treat and evaluate injured workers. While this approach has been used by large employers for decades, small to mid-sized companies often found it cost prohibitive to implement these programs.
Telephonic Claims Triage Services
A handful of companies have recognized the need for affordable claims triage within small to middle market businesses and adopted telephonic claims triage services as a result.
How the Process Works
In the event of a workplace injury, the employee is directed to call the triage service immediately and while still on the worksite. The injured employee is then connected with a nurse who takes a recorded statement and will from there diagnosis the extent of the injury. If the injury requires medical treatment beyond first aid, the employee is directed to the employers occupational health clinic. If the situation requires emergency medical treatment, the employee is directed to the closest Emergency Room. The benefit of claims triage exists in the situations where nurses are able to diagnose the injury as one that simply requires self care and over the counter medication rendering the employee able to return to work quicker without a costly claim.
Benefits to Claims Triage
- Reduces claim frequency
- Cuts costs of many large claims
- Reduces OSHA recordable counts
- Protects or limit fraudulent claims
- Improves productivity and morale
- Improves claim reporting consistency
- Increases Preferred Provider network penetration
- Instant information leading to early intervention and prevention
- More targeted health care
- Train registered nurses
- Independent medical reviews
- Supervisors collaborate in decision and stay involved
- Assured of call-back access 24/7
- Immediate communication
Many of the triage providers assert their services reduce workers' compensation claim frequency by 30% by appropriately diagnosing injuries that can be addressed via first aid and self-care. A 30% reduction in claim frequency will have a dramatic impact in the employers experience modification rating, OSHA recordable injuries and ultimately the costs associated with their workers compensation.
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