Workers' Compensation Program Improvements: Looking Back and Ahead
By Ron Davies
New Hampshire Local Government Center (LGC) Property-Liability Trust's Workers' Compensation Program completed nine months of handling claims in-house in September. Since taking over claims administration from our previous Third Party Administrator (TPA), the following has been accomplished:
Enhanced communication between LGC members and Workers' Compensation Program claim representatives. We provide 24-hour contact with our members and their injured workers after we receive notice of a claim. This occurs on all claims involving medical treatment and/or lost time from work. If a claim involves lost time from work in excess of seven days, a senior claim representative will go out and meet the injured worker in person for fact-finding purposes and explain the benefits of workers' compensation to them.
In addition, our claim representatives keep members up to date throughout the life of their injured employee's claim. We also encourage input from our members. This action has resulted in our ability to close claims in a more timely fashion than with our past TPA.
A new claim review program involves an LGC senior claim representative meeting with a member's administrator. As part of this review process, the senior claim representative actively discusses the member's claim files. Status and action plans are provided by the claim representative, who also encourages and receives feedback from the member's administrator. This allows our members to be a vital part of the claim process. Findings show that when all interested parties are involved with a claim, from beginning to end, better outcomes result for everyone.
An onsite Nurse Case Manager (NCM) within LGC's Claims and Coverage Department works closely with injured workers and their medical providers to assure the needs of the injured worker are met. There are times when the NCM will go to a medical appointment with an injured worker to ensure they receive the maximum benefit from that appointment. The NCM will also coordinate the injured worker's medical status with our member to assure the injured worker is able to return to work safely and at the appropriate time.
Upon occasion, the NCM will accompany an LGC senior claim representative to meet with a member's administrator in order to best explain the benefits of bringing an injured worker back to work on a light duty or temporary alternative job. Our NCM has helped numerous injured workers return to work at the appropriate time, thus saving our members the cost of unnecessary lost work time.
In the coming months, LGC will introduce a new web-based reporting tool that will enable members to securely report claims online via a log-in and password-protected feature from RISKMASTER®, the industry's leading independent system for risk and claims management. Once a claim is electronically reported, an acknowledgement and claim number will be automatically generated back to the member. This integrated technology will help increase the efficiency of LGC's Claims and Coverage Department and also makes it easier for members to report a claim.
Beginning in 2011, our Workers' Compensation Program claims staff will team up with LGC's Health and Safety Department advisors to offer educational presentations regionally to members. These presentations will concentrate on preventing losses, what members should do when a loss occurs, what investigative work members can conduct to assist our claim representatives and procedures that can help injured employees return to work on a part-time, light duty basis.
We've come a long way in a short period of time, but we want to enhance the workers' compensation process for members even more. Our goal over the coming year is to get our members more actively involved in the claim process by offering more training. Our entire claims team looks forward to further collaborating with LGC members in the days ahead to help keep your workers' compensation claim costs to a minimum.
Ron Davies is assistant claims manager of workers' compensation at New Hampshire Local Government Center. He can be reached by calling 800.852.3358, ext. 262, or by e-mail.