By Donna Motley, Director of Claims

Communication in our industry is crucial. We have at our disposal multiple ways to communicate, telephone, computer (e-mail), faxing, even the old fashion form of “written” communication. In the Workers’ Compensation arena, we still need “written” proof of a claim. As you are aware, the Employers Basic Report of Injury (Form 100) must be submitted before we can physically set up a claim file. Obviously, the form needs to be completed properly in order to fill in the fields required by the computer. Claim information is tracked by the State of Michigan – hence the required fields.

Obviously a delay in submitting the claim information, through any means of communication, results in a delay in the employee receiving appropriate medical treatment and possibly a return to work; a delay in medical bills being processed and paid; the increased possibility of excess medical treatment being rendered and thereby increased costs; and overall, customer frustration and dissatisfaction. While we all have the same goal in mind, i.e. proper handling and recovery of an injured employee while only paying for legitimate claims and expenses, it sometimes depends upon which side of the fence you are sitting on as to what is deemed “proper”.

Workers’ Compensation claims handling is governed by the State of Michigan Workers’ Disability Compensation Act and Administrative Rules which is a 230 page book. Health Care Services Rules, which governs appropriate medical treatment and payment of medical bills, consists of 137 pages, which does not include the actual fee schedules and codes. The “amount” paid for services is not something we have control over or can negotiate – the Rules govern.

If a provider disagrees with the payment amount, there is an appeal process in place with the State. The best way we can control costs is to receive the claim promptly (within 24 hours of occurrence) and direct medical treatment.

Please remember, the injured worker is responsible for providing the employer with a current disability slip following a medical appointment. This would be the process for the employer to be kept informed of their employee’s medical status. Some employers have direct contact from the occupational clinic they utilize. We have no way of knowing what arrangements our insureds have established. An insured would have to let us know if they want direct contact from our department following their employee’s scheduled medical appointment. However, we are not always able to obtain medical information on the day of the appointment.