It’s frustrating when you suspect that a Workers Compensation claimant is milking the system. However, you can reduce potential malingering significantly if you attend to it from the get-go.
Start by designating a manger as the “firm’s rep,” to ensure that any employee who makes a Comp claim gets a doctor promptly and to inform your insurance company immediately. The rep should transport the employee to the physician, stay at the office during the examination and treatment, and then take him or her home or back to work.
While at the doctor’s office, the firm’s rep should ask the physician about the medical condition, recommended treatment, and a reasonable return-to-work date. If the claimant or physician objects, the rep should assure them that he or she will work with the insurance company to make sure all reasonable and necessary benefits and medical bills are paid.
Resist any employee excuses for not seeing a doctor. If the employee has an attorney, suggest getting a second opinion (which you will provide at no cost). If the claimant already has a doctor, have the firm rep offer to take him or her for a consultation– and ask about diagnosis, treatment, and return-to-work status.
The rep should then: 1) follow up with the employee at least every two weeks – and more often if possible – face to face or by phone; and 2) stay in touch with the claims adjuster to share information about visits with the doctor and claimant that might help him or her return to work as early as possible.
Although these techniques won’t always work, anecdotal evidence suggests that they can reduce malingering claims by up to 70%.
What’s not to like?
