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.
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 all parties are aware of the prognosis, early return-to-work possibilities, medical care, or rehabilitation needs. The claims adjuster directs these efforts.
We strive 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.
Provider Bill Review
We review every medical bill to ensure that appropriate codes are used and payments are made according to your state's regulations and fee schedule. We also conduct training within the medical community on correct billing procedures.
Preferred Provider Networks
We have an agreement with a network of hospitals and physicians that offer quality care at discounted rates. A listing of all preferred provider physicians, facilities, and hospitals is available by clicking here or by calling our Claims department at (385) 351-8010.
Medical-case managers provide onsite evaluation of an injured worker's situation and coordinate with healthcare providers to facilitate recovery and return to work. We also have 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 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.
Utilization review (UR) is a process that examines the treating medical provider's plan of care and provides recommendations concerning the appropriateness of the proposed medical treatment. UR's purpose is to review the safety and efficacy of medical services, such as surgery, diagnostics, therapy, durable medical equipment, medication, etc. UR is a collaborative program that protects injured workers and educates medical providers on evidence-based guidelines, new research, and best practices. UR's goal is to promote optimal patient outcomes that emphasize functional recovery and quality of life.
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 our Safety department at (385) 351-8103 for assistance in establishing a program for your company.
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 us 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.