Injury reporting and efficient claims management
By Dustin Napier, Account Executive, Sedgwick MCO

Workers’ compensation is a “no fault” system in Ohio. Every state has laws and regulations mandating the prompt reporting of all injuries and accidents. Most of these laws are in place to protect the rights and benefits of injured workers, but what many employers do not realize is that organizing the injury reporting process protects both the employee and the employer. A study by the National Council on Compensation Insurance (NCCI) showed that delayed reporting can increase workers’ compensation claims costs up to 51%. The study also reported that the longer a claim goes unreported, the more likely it will be to involve litigation, another major cost driver.

At Sedgwick Managed Care Ohio, we handle approximately 50% of workers’ compensation claims incurred throughout the state.  Our data indicates a similar trend.  Looking at claims reported between 2020 and 2024, we find that earlier injury reporting correlates with fewer lost workdays per claim.

The increase in premium from only one significant claim could dramatically impact your rates for several years and interfere with your access to group discount and rebate programs. In addition to the costs of premium, you will also have indirect costs when an injured employee is off work. Hiring and training of replacement workers, loss of production, lower quality, and possibly future business loss are potential factors that should be considered when evaluating injury costs.  Many employers are in a position to help the injured employee tremendously by establishing a clear process and staying connected throughout the life of the claim.  There are some simple steps every employer can follow for an effective program.

What can an employer do to help reduce claims costs?

1. Prompt Reporting: Employer involvement to ensure prompt reporting is an absolute must for any successful workers’ compensation program. Establish internal reporting procedures and policies and educate your entire staff on the importance of prompt and thorough incident reporting. Your MCO can help by providing materials such as posters, ID cards and injury reporting kits, and can also help you craft and train staff on the policies and procedures to govern program. Early clarity on the incident and mechanism of injury facilitates better decision making by all parties involved.
    
2. Maintain Contact: It is critical for employers to stay in touch with the injured worker while they are off work. Make sure they understand who their primary contact should be within your organization and encourage them to stay in touch. Employees who do not hear from the employer can experience frustration and anxiety about their employment situation, often leading the to seek legal counsel unnecessarily. This contact will help maintain their confidence, positive attitude and willingness to return to work. A brief telephone call once or twice a week is all it takes.  Your MCO will also be in contact with the injured worker as well, but nothing replaces a call directly from you, the employer.  When your employee seeks answers or advice from outside sources, matters can become more complicated, unpredictable, and expensive.

3. Know the Doctor: Establish a working relationship with the medical providers in your area. These providers should become familiar with your operation and policies, provide prompt quality care, timely updates, and be available to discuss cases when needed. Your MCO most likely has a provider services department ready to assist you with this process.

4. Offer Transitional Work: Every successful workers’ compensation program recognizes transitional work as an essential component. If you do not have a formally written plan, at least be flexible in considering transitional duty options to prevent workers from being off work. Transitional work can eliminate the need for the BWC to pay disability, which causes the greatest impact on your premium rates.

Sedgwick MCO is conducting a webinar on Injury Reporting on February 11, and we invite you to join us.  Click HERE to register.

If you already have a favorable claims experience, you should be congratulated.  But don’t relax, be cautious and prepare. Continue your oversight and involvement to ensure your good claims experience is protected.  Setting up a proactive workers’ compensation program right now will be time well spent as it will protect your organization from unnecessary future workers’ compensation costs.

For more information contact Sedgwick MCO's Dustin Napier at dustin.naper@sedgwickmco.com.