When people picture what drives the cost of a workers’ comp claim, they picture the injury and the treatment. On most claims that run long, the treatment is not where the time goes. The time goes in the gaps between the appointments: waiting for an authorization, waiting for imaging to be scheduled, waiting for a report to reach the adjuster, waiting for someone to call the employee back.
Nobody owns those gaps by default. The provider treats the employee when they are seen. The adjuster works the file when it reaches them. The employer often assumes both are moving it along. Each assumes the next step is someone else’s, and the claim sits.
What the gaps look like
An appointment ends with a plan: physical therapy, imaging, a follow up in two weeks. Then the therapy needs approval, and the request sits in a queue. The imaging order is written but nobody schedules it. The follow up is booked, but the imaging is not done in time, so the visit is spent ordering it again. The employee, at home and on reduced pay, hears nothing for ten days and calls a number on a billboard.
Every one of those waits adds days to the claim, and the employee experiences all of them as silence.
The protocol
One owner for every open claim
At the employer, one person, with a backup, keeps a short list of every open claim with the next scheduled step and its date. Not the adjuster’s file, not the provider’s chart. A list the employer controls, reviewed every week.
Every visit ends with a next date
After each appointment, the owner confirms three things: what the plan is, what has to happen before the next visit, and when the next visit is. If any of those is unknown, that is the follow up call to make that day.
Chase the authorization, do not wait for it
When treatment or imaging needs approval, the employer’s owner confirms that the request was sent and when an answer is expected. A polite call to the adjuster on day three moves more claims than any number of complaints on day thirty.
Call the employee every week
A short weekly call from someone at the employer: how are you doing, what is next, is there anything you need from us. It costs a few minutes, and it is the single best defense against an employee deciding that nobody is looking out for them.
What to measure
- Days between scheduled visits on open claims
- Days from a treatment or imaging request to its approval
- Percentage of open claims with a documented next step and date
- Percentage of injured employees contacted by the employer each week
- All of the above, by location
Where to start
List every open claim today with its next scheduled appointment. Any claim without a date on it is a claim that is waiting on someone, and finding out who is the first call to make.
The appointments are where the healing happens. The time between them is where the cost builds, and it is the part the employer can manage.