7 Major Reasons Why Med-Only Claims Can Become Lost Time

Lost-time claims can result from medical-only claims. Yes, this is possible and most employers get surprised when it happens. When companies find out that a previous medical-only claim, no matter how minor it was, has become a lost-time claim, it can be such a hassle for the employer.

It’s one surprise you don’t want to hear because such can be prevented beforehand. It can be avoided but sadly, because of some negligence, medical-only claims become lost-time claims after some time

Here are top reasons why unfortunate things like this happens and what an employer can do to prevent such from happening:

1. Inappropriate Initial Medical Care
Admit it or not, some employees don’t always go to the best medical provider for their on-the-job injury or accident. More often than not, they just go to where it is convenient or near. Some family doctors are always quick to advise and say an employee could stay at home until the injury heals. However, nobody remembers the modified or light-duty program usually offered by the employer.

Preventive Measure: Always choose the best medical provider. Don’t go to the wrong type of medical provider. The employer must prepare a list of approved medical providers where employees can easily refer to in case of an injury or accident.

Employer or the work compensation coordinator must verify if the injured employee goes to a medical provider in the list of approved or at least pre-screened companies specializing in modified duty programs or workers’ compensation.

2. No Triage
Things can get out of hand if there is no post-injury process for the employee. He or she must be kept in the loop to make sure medical care is well coordinated. The benefits of having a triage nurse include having an initial assessment of the injury by phone using medical protocol. A triage nurse must provide the names of approved or pre-screened doctors or medical providers to the injured employee.

A triage nurse must help determine if emergency care is really needed or a simple visit to a clinic within two days is enough. The triage can help advise if an injured employee simply needs to rest. A triage personnel should provide the names of medical doctors who can attend to the patient.

Looking at past statistics, only half of triage calls really require a medical doctor. Because of this, claims converting to lost time claims are less than half.

Preventive Measure: An injured employee must call triage for advice. Triage will then inform the medical provider if there is light-duty work available for the employee, as well as, the schedule of future medical appointments. The triage must follow through to make the employer aware of the medical status of the employee and when he will be able to back at work.

3. Questionable at the Start
A fraudulent claim is a no-no. Some employees decide to have “accidents”. These are those not witnessed by anyone or consist of subjective pain and strain complaints. It is up to the employer to investigate on the matter. The adjuster must also cut off the fraudulent claim as soon as possible before it becomes a lost-time claim.

Preventive Measure: If an employer suspects of a fake claim, he must inform the adjuster immediately. An in-depth investigation must be done to make sure the accident really happened. Employer or adjuster must inform the doctor before an employee goes to him for appointment and checkup and tell him of the modified-duty program that will be provided.

An employer must also start a campaign within the workplace to inform employees that work compensation fraud will be prosecuted.

4. Severity of Medical Condition
On the other hand, an injury can be more severe than originally reported or suspected. There will be times that conservative medical care is not enough. It is recommended that a medical provider or doctor check the injured employee thoroughly to determine if complain is valid or is actually worse. An employer must make sure the correct doctor’s recommendation is followed all the time. Quality and prompt medical care must be provided to any employee and the appropriate transition duty program must be in place.

Preventive Measure: An employer must be involved in the workers compensation claims of the employees. Look into all and not just the severe ones. By doing this, the employer can prevent medical only claims from becoming indemnity claims. Employer must prepare a work compensation management program as part of overall risk management program to control such situation.

5. Tough It Out
Some injured employees are allowed to “tough it out”. However, this usually makes mild injuries become severe. Don’t be afraid to go to a doctor or approved medical provider for a checkup. Don’t be concerned about what your co-workers will think of you; you’re not as tough. It is better to be safe than sorry so report an incident immediately to be sure. A light duty can become a temporary total disability if appropriate medical attention is not given. Always go to a medical provider approved by your employer.

Preventive Measure: If an employee reports the injury is nothing, require him to go to a medical provider. Employer must pay for the initial visit and assure him that he can be excused from work for the time being.Communicate with the employee and show concern for his welfare. You don’t want a “tough it out” situation to turn into an indemnity claim, do you?

6. Something for Nothing
Some injured employees simply take a vacation on work compensation. Problem is, this could make things worse for the patient. A minor injury can become a lost-time claim if the employer fails to control medical situations and offer light duty programs.

Preventive Measure: Employer must be ready by informing employees about their obligations should there be an injury or accident. Transitional duty must be assigned and still expected of the injured employees.

7. Inattention
There are employers who ignore medical-only claim. Don’t ignore such and always check on the claims because you don’t want them to turn into lost-time claims. Investigate on the injury or accident, contact a doctor or medical provider, and inform the people involved of the light duty program. Also do a follow up because some employees might take advantage of the situation.

Preventive Measure: Evaluate the post injury response carefully. Don’t just trust the employee of his claims. Have the case investigated thoroughly so you’ll know what to do. Have the injured employee to bring a Work Ability Form to the doctor on his initial visit or checkup. Employer must have the right forms at all times for future reference.

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