Claims Management

Workers’ compensation laws vary by state.  The following is a general overview based on features common to workers’ compensation insurance in most states.  The benefits and programs described below may not be available in all states.

Claims Management
Our claims services bring together experienced adjusters and sophisticated systems with  preferred provider networks, prescription drug discounts, provider bill and utilization review, medical case management, and vocational rehabilitation services when appropriate. This combination gives injured employees a solid foundation of care and support to foster a quick recovery. It also allows our policyholders to participate in controlling claims costs.
 
After an Injury
Injured employees should report any work-related injury as soon as possible, regardless of severity. Encouraging your employees to report injuries promptly may significantly reduce claim costs. 
 
As the Employer, You Should:
1.  Ensure that the injured employee receives appropriate medical care in a timely manner. Notify the employee of your designated physician or clinic if allowed in your state.
2.  Immediately report the incident to WCF Insurance. (When you file the claim with WCF Insurance, we will report the claim to the state regulatory body). Click here for reporting requirements for your state or contact your adjuster for more information.
3.  Obtain the names and contact information of anyone who witnessed the accident or who may be able to provide additional details.
4.  Conduct an investigation to document the circumstances surrounding the injury. 
     - Look at the accident site. 
     - Determine why the accident happened. 
     - Secure evidence by taking photographs or retaining any tools or equipment involved in the accident.
 
Controlling Claims Cost
Good claims cost management will eventually save you money in premiums. There are several ways to decrease claims costs, including:
 
Disability Management
Disability management is the process of coordinating efforts to return an injured worker to work as soon as possible. The claims adjuster, employer, medical provider, and injured worker communicate the status of the case so that all parties are aware of the prognosis, early return to work possibilities, medical care, or rehabilitation needs. The claims adjuster directs these efforts.
 
Managed-Care Programs
WCF Insurance strives to provide injured workers with quality medical care by using managed care. The average length of a hospital stay has been reduced by utilizing these programs, which has saved millions of dollars. These savings are passed along to you through reduced premium rates and safety record adjustments. The following programs have been implemented for your benefit:
 
Provider Bill Review
WCF Insurance reviews every medical bill to ensure that appropriate codes are used and payments are made according to your state's regulations and fee schedule. They also conduct training within the medical community on correct billing procedures. 
 
Preferred Provider Organization (PPO)
WCF Insurance has an agreement with a network of hospitals and physicians that offer quality care at discounted rates. A listing of all PPO physicians, facilities and hospitals is available by clicking here or by calling our Claims Department at 385.351.8010.
 
Medical-Case Management
Medical-case managers provide onsite evaluation of the injured worker's situation and coordinate with health-care providers to facilitate recovery and return to work.  WCF Insurance also has a specialized team to monitor injured workers with catastrophic injuries. All WCF Insurance medical-case managers are registered nurses with specialty certifications in disability and rehabilitation. For more information click here
 
Vocational Rehabilitation
Vocational Rehabilitation focuses on returning the injured worker to work in a timely manner. Counselors coordinate with employers and physicians to verify work capabilities and assist with job modifications. They can also assist employers in developing their own return to work programs.
 
Return to Work
You will reduce your premium costs by helping injured workers return to work as quickly as possible after an injury. Through early and frequent contact with injured workers, you can also help their anxieties about the injury, medical treatment, and their jobs. When injured workers are partially disabled and can't return to their regular duties, you can decrease claim costs by finding other duties they can perform with a return-to-work program
 
Drug and Alcohol Testing
Many companies have realized significant reductions in workers' compensation claims by initiating pre-employment, post-accident, and random drug testing. Review 10 reasons to implement a drug-free workplace policy. Please contact WCF Insurance's Safety Department at 385.351.8103 for assistance in establishing a program for your company. 
 
Third-Party Claims
Subject to the requirements of state law, employees who are injured by a negligent third party may either file a civil action against the third party or assign the cause of action to WCF Insurance. If the injured worker assigns the action to WCF Insurance, we can take legal action against the third party on behalf of the injured worker and recover our expenses.
 
WCF Insurance may have a statutory lien on any amount an injured worker collects from a third party. In other words, any money recovered in the third party action suit can be used to offset the amounts paid for the workers’ compensation claim. This will keep claims costs down and eventually decrease your premiums.
 
Information from the Employer's First Report of Injury or Illness Form helps WCF Insurance identify any liable third parties. The most common third party situations include motor vehicle accidents, domestic animal bites, defective products, faulty rental equipment, assault, explosions, toxic spills or leaks, slips and falls, and construction site accidents. Always save defective products or faulty equipment as evidence in case there is a third-party lawsuit.
 
Fraudulent and Questionable Claims
If you suspect a claim is fraudulent, or if there were questionable circumstances surrounding an injury, thoroughly document the incident and contact your WCF Insurance claims adjuster immediately. Documentation should include written statements from the injured worker, supervisor, all witnesses to the accident, and the person to whom the claim was reported. Proper handling of questionable and fraudulent claims can save you money. If you suspect a fraudulent situation involving other employers, medical providers or injured workers, call our Fraud Hotline at 385.351.8140, or 866.FRAUD.50. WCF Insurance will actively investigate the incident on a confidential basis.
 
 

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Insurance coverage in all states other than Utah is provided by Advantage Workers Compensation Insurance Company, a wholly-owned subsidiary of WCF Mutual Insurance Company, doing business as WCF Insurance. Advantage is domiciled in Indiana; NAIC number: 40517. Administrative office: P.O. Box 571918, Salt Lake City, UT 84157-1918.
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