What is the definition of a simple Workers’ Compensation (WC) claim? Typically, claim professionals define a simple WC claim as one that only involves medical treatment with a return to work so that no indemnity dollars are involved in the claim.
Examples of these types of claims include: cuts, bruises and minor strains. With these medical-only claims, the employee is treated and then returns to work with no long-term impairment. In other words, after a conservative course of treatment, they are back to normal. Seems like that should be pretty “simple”, but the process involves the injured worker, the employer, the insurance agent, the medical provider and the insurance carrier. So, it can get complicated without a clearly defined process.
The Ins and Outs of a Medical-Only Claim
The good news is that Amerisure has a proven process that begins as soon as the claim is reported. While the exact process varies by state, let’s explore how the process usually plays out:
Wrapping Up the Claim
All of these steps are required for a work-related injury, so it’s not surprising that the average timeframe for a medical-only claim to close runs from 45 to 90 days. Amerisure’s claims team works closely with the risk management team throughout the claims process to help the employer develop a plan to avoid recurrence of similar claims.
“We have a service team approach to all Workers’ Compensation claims, which includes partnering with our Risk Management Consultants and Marketing Underwriters within Amerisure,” commented Kerri Friederich, ACA, CCP, Workers’ Compensation Unit Manager at Amerisure. “That’s what sets us apart from other carriers; Our holistic approach for better claim outcomes. Then we work with network providers who understand work-related trauma, manage our pharmacy utilization with a prescription benefit manager and all while assuring accuracy of our claim spend through bill review. And, since we provide same-day contact with employers, we can identify anything that needs special attention from the get-go.”
In other words, a simple medical-only Workers’ Compensation claim at Amerisure is managed through a tight but empathetic process that helps the employer manage the medical component of these losses. That adds up to lower costs for the employer and better outcomes for employees.