How to Fight Back Against Workers’ Compensation Fraud, Part 2

return to work pt2

Part Two of Two on Fighting Fraud with Insured Solutions

In our last blog, we told you a little about Workers’ Comp Fraud and how it can be committed, either knowingly or unknowingly, by both employees and health care providers. Today’s subject matter is a little brighter – we’ll explain Insured Solutions’ step-by-step plan to combat Workers’ Comp Fraud and get businesses (and their employees) back on track after an injury.

Pre-Step: Preventative Risk Management Services

The first step in Insured Solutions’ fight against fraud actually occurs before an injury or a claim ever takes place. Insured Solutions offers on-site and online risk management that helps employers understand how to anticipate fraud and minimize the damage – or sometimes, prevent it completely.

  • Pre-hire screening training gives employers certain techniques to help them hire trustworthy workers.
  • Drug & Alcohol Programs offer guidance on addressing this very costly workplace problem.
  • Safety training focuses on behavior modification and is created specifically for the employer’s industry to cut down on both major and minor accidents.
  • Claims administration and return-to-work safety helps employers understand the step-by-step events that should take place upon the onset of an injury in order to maintain employer rights and keep a claim from spiraling out of control.

All of these services are provided at no additional cost, and the training comes either online and/or in person.

Step One: Registered Nurse Triage

When an employee is injured, Insured Solutions receives the claim immediately, and their first step is to coordinate all the information about the claim in writing. Insured Solutions’ nurses do a three-point contact with the employee, employer, and doctor to coordinate the best information and provide it directly to the insurance carrier. Sometimes, the registered nurse is able to triage the claim in such a way where the employee may not have to go to a doctor or hospital. Minor injuries may call for aspirin, elevation, icepacks, or something very simple that the employee can do at home. Additionally, nurses are skilled at identifying “red flag” claims, offering a valuable heads up on a potential problem.

Step Two: Claims Adjusters Gather Data

A claim comes with a ton of paperwork, and it’s the claims adjusters job to get it all filled out – and fast. On behalf of the employer, these people do the major leg work, gathering data as it relates to the employee, the doctors, and the employer. Insured Solutions’ Claims Adjusters are in a unique position to provide information about wages and other specifics that employers working alone may not have time to immediately gather.

Step Three: Encourage Light Duty with Doctors

Along with nurses, claims adjusters are also in touch with the doctor to let them know that a light duty position is available immediately. The encouragement of our nurses can help the doctor feel comfortable sending a release form for light duty with instructions. Additionally, a dedicated claims adjuster or nurse is selected to follow up regularly so that this important piece of documentation doesn’t get put off by doctors or fall through the cracks.

Step Four: Notify the Employee of Light Duty

Insured Solutions helps employers notify their employees about the offer for light duty and properly track the employee’s refusal or acceptance of this offer. If the employee accepts, Insured Solutions coordinates all the next steps and administers the light duty 100% – even at the employee’s home, if necessary. If the employee refuses, the employer can feel confident that documentation of their refusal was captured properly and the free payday can be rightfully withheld by the insurance carrier and the employer.

This may be a simplified overview, but you can see easily enough how Insured Solutions’ process works quickly and effectively to build an impenetrable wall that keeps fraud out, or limits the damage that leads to higher premiums. If you’re interested in learning the finer details of this process, download the white paper or contact Insured Solutions today.

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