Workers' Compensation Claims Management That Works
By Scott Simmonds, CPCU, ARM, CMC

Successful workers' compensation claims management begins with a procedure by which injuries are reported. Prompt reporting of claims is vital. Call your workers' compensation carrier ASAP once an injury occurs to get the system moving. Fast reporting is essential for even the smallest injury.

Employers should take several steps to develop a claims management procedure:

Choose a designated medical provider - Maine law allows employers to direct the initial treatment of injuries. Ask your insurer or agent to provide you with a list of their designated providers. Maine Employers Mutual has an excellent list on their website: http://www.memic.com. Make sure all employees know who the provider is and how to contact them. Post on the employee bulletin board the name, address and phone number of the provider.

Determine how your insurer wants you to report claims - Most workers' compensation carriers have set up toll free hotlines for the initial report of injuries. Some still want you to fax a form to them. Find out ahead of time what your carrier wants.

Decide what one person or position in your company will take the reports - All workplace injuries should be reported to a central location within a company. Usually, an injured employee notifies their supervisor of the injury. The supervisor then directs the employee to the safety coordinator or personnel office to formally report the claim. Having each supervisor handle the reporting of their department's claims does not usually work. Have a central reporting process with one person responsible. Provide for a backup too.

Employers should have a system in place to monitor claims after they have been reported. Insurance Consultants of Maine uses a quarterly review program where we touch base with the insurance company adjuster on any claim that is open. In this way we can monitor what has happened, what is happening and find out what is planned for each claim. Aggressive follow-up will prevent claims from falling through the cracks.

Here is a list of the toll free claim reporting numbers for some of the workers' compensation carriers in Maine: