"CLAIMS"
For many, the word is not exactly synonymous with "cost savings." But for employers in the know, claims often have a silver lining that represent an opportunity to both save money and strengthen the bond between employer and worker. Although claims are never good news for a business, the financial and productivity losses that go with them can be minimized substantially.
Before exploring how to save money when a claim comes up, it's helpful to know when to file a claim versus when just to write up an incident report (
Form S-767).
An incident report is filled out when no treatment beyond first aid is sought, and the worker doesn't ask to file a claim. Incident reports do not impact your workers' comp rates, although if your business finds itself generating incident reports frequently, it would be a good idea to look at why so many incidents are occurring. Even if you are filing a claim, it is still a good idea to fill out an incident report in order to track and prevent future incidents.
A claim is filed when any of the following occur:
- A worker seeks treatment from a medical provider.
- A worker asks to file a claim.
- A medical provider files the initial medical report (Form 827).
- A manager or supervisor witnesses an incident that he or she thinks will likely result in a claim.
- An attorney notifies the employer or the insurer about an on-the-job injury.
The right way to go about it
The first thing to remember about filing a claim is to do it quickly. A timely filing not only means that your employee may get back to work faster, but there are other, less well-known benefits:
- The sooner you file a claim, the sooner SAIF can talk to the injured worker and any witnesses and get information before the details of what happened get foggy. This will help SAIF make a prompt and accurate decision about the claim, which will be better for all parties involved.
- Workers can take advantage of the Oregon Prescription Drug Program (OPDP), which provides access to certain generic medications (if prescribed) at no out-of-pocket cost to the worker. Because a claim number must be assigned in order to trigger the worker's eligibility for the program, timely filing is important. Even before a claim is accepted, the injured worker has access to OPDP's First Fill pharmacy program. If the claim is accepted, the employer's cost for OPDP-provided medications is far lower than the typical out-of-pocket price. If the claim is eventually denied, neither the worker nor the employer will be billed for the medication paid through this program.
A claim should ideally be filed within five days of an incident. If the claim is accepted, benefits to the worker will follow in a timely manner. If a disabling claim is denied within 14 days of your date of knowledge, no time-loss benefits are due.
Return-to-work programs
When an injured worker has been restricted from performing regular duties because of an on-the-job injury, employers should partner with SAIF's return-to-work (RTW) consultants to keep the employee working at tasks appropriate to his or her physical capabilities. Our history shows that when employers access SAIF's RTW services, approximately 80 percent of workers with a disabling claim return to work within 60 days. Typically workers are put on temporary, light-duty work, which can be beneficial for both the employer and worker. Using this program:
- The ultimate cost of benefits is often decreased.
- Knowledgeable workers are retained. Replacing a good worker costs both time and money.
- You may be able to keep your premiums lower by having less time-loss.
- The injured worker's career can benefit because of new skill-sets gained.
In addition, workers participating in a return-to-work program may have less need for medical benefits because work is frequently therapeutic and they recover from their injury faster. Because they get back to work faster, time-loss costs are reduced or eliminated, and permanent partial disability may be avoided. There is another advantage of using a return-to-work program: If a worker returns to regular work or some other suitable employment, vocational assistance costs are avoidable or unnecessary. And if worksite modifications or special equipment purchases are made through access to the reimbursable programs funded by the Workers' Benefit Fund, the improvements may help the employer avoid further injuries in the workplace.
Employer-at-Injury Program (EAIP)
When an employee's injury temporarily impairs the ability to perform regular work, the employer may be eligible for EAIP benefits. The Employer-at-Injury Program provides financial assistance to employers who provide temporary, modified work to injured workers who have been medically restricted from performing their regular job duties. Benefits may include wage subsidy, or funds to purchase equipment or modify a worksite in order to help that employee do his or her work.
EAIP is a voluntary program, is not a claims cost expense, and does not affect the employer's premium. Insurers like SAIF administer EAIP and help employers to incorporate the program into their return-to-work procedures.
Preferred Worker Program
Like EAIP, the Preferred Worker Program is funded by the Workers' Benefit Fund, and it is administered by the Department of Consumer and Business Services (DCBS). Available for workers who cannot return to regular work because of permanent impairment or disability, this program provides incentives or worksite modifications to assist an employer in hiring an injured worker into suitable employment.
Reprinted from Comp News, Fall 2009, Part three of three
View Controlling your workers' comp costs | Part one | Part two
Handouts on controlling your costs:
Understanding your rates | Filing and managing a claim | Safety and injury prevention