Many
employers have questions about what happens after they report a
claim. You may also wonder how an ecovery program fits into the claims
process.
1. The
claim is reported to Eastern and assigned to a Claim
Representative. Prompt reporting is very important to the process! Your claim
should be reported immediately so that Eastern can begin managing it
appropriately.
2. The
injured worker seeks medical attention and treatment begins; if you have a
medical provider panel in place, you may need to have the employee sign an
acknowledgement form prior to treatment (except in an emergency situation).
Physicians should be informed that the injury is work-related and that you have
a Return to Wellness (RTW) program. This way, the treatment plan can be
tailored with the goal of restoring productivity and a return to the workplace.
All medical bills should be submitted for Eastern’s review.
3. Eastern
initiates a 3-point claim investigation, contacting the injured worker, the
employer and the medical provider. This investigation will result in an
approval or denial of the claim. Regular contact among all three parties is
encouraged and plays an integral role in a successful outcome.
4. Eastern
obtains wage information to determine the amount of weekly wage benefits the
injured worker will receive.
5. Reserves
are developed based on disability and medical diagnosis, treatment plan and
your ability to offer modified duty.
6. Eastern
investigates any viable subrogation possibilities.
7. The
medical provider addresses the injured worker’s ability to work by reviewing
your pre-injury job description and proposed modified duty job description.
8. You
should then utilize the ecovery modified duty task lists and the restrictions
provided by the treating physician to develop a modified duty job offer.
9. The
injured worker returns to the workplace, performing modified duty within the
physician’s restrictions.
10. The
injured worker continues to recover, receiving the physical, financial and
psychological benefits of returning to modified duty. Additional medical
treatment continues, as appropriate, and the treating physician periodically
re-evaluates the injured worker’s work capabilities.
11. Your
designated Risk Management Consultant reviews the accident information and will
make recommendations to prevent future injuries.
12. The
injured worker is either eventually released to his/her pre-injury job without
restrictions, or is given permanent restrictions. The outcome is influenced by
a variety of factors, including jurisdiction, job availability, the individual
details of the claim, and other considerations.
13. Any
additional benefits due are paid and the claim is brought to resolution.
ecovery’s
Return to Wellness philosophy is linked to every step of a claim! Modified duty
options should be consistently re-evaluated and monitored to achieve the best
possible outcome for all parties.