by Lindy Z. Kerr, Esq.

Some claims are just more difficult to manage efficiently and effectively than others. A difficult claim may be due in part to the type of injury sustained or the severity of the injury, the authorized treating physician on the claim, or even the attorney on the other side. Other times a claim heads south over time.

Below is a list of tips to employ, both to keep your claim from heading south and to salvage a claim that has gone bad. The tips are taken form Proactive Measures to Salvage Your Claim in a Workers’ Compensation Setting, the Defense Perspective, an article recently published by Ken David & Associates in conjunction with the State Board’s annual educational conference.

Tip # 1: Maintain a good, valid panel of physicians
A good panel is one that contains qualified physicians who will help “effect a cure, give relief or restore the employee to suitable employment.” However, the physicians on the panel should also understand the goals and limitations in Georgia’s workers’ compensation system. In particular, it is important to try to select physicians who understand treating all of the injured worker’s aches and pains is not necessarily the same as treating the work injury.

In addition to selecting physicians who are skilled in their area and who are familiar with worker’s compensation, employers and adjusters should not be afraid to become familiar with the providers on the panel and develop a professional relationship with them. When the medical provider has a good working knowledge about the job the employee performs and work accommodations that are available, the physician will be better able to understand whether a particular mechanism of injury makes sense objectively and whether it would be possible to keep the employee at light duty restrictions.

Tip # 2: Consider nurse case management
Nurse case management is an effective tool on claims complicated by numerous medical providers or a complicated medical issue. A good nurse case manager ensures all of the medical treatment is coordinated consistently and timely. The communication provided by the nurse case manager often will prevent delays in medical testing, treatment and recovery, thereby helping keep the claim on track. Although claimant’s attorneys are thought of as oftentimes objecting to nurse case management, you may find the claimant’s attorney is actually agreeable to nurse case management, but just not with a particular provider. If that is the case, then the parties may be able to work together to find an agreeable nurse.

Tip # 3: Communicate
The positive impact of communication between the parties should not be underestimated. While it may not always be possible, in most cases, the parties can resolve their differences through candid communication. From the defense perspective, we ultimately want to close the file and along the way want to make sure an injured worker receives appropriate medical treatment that will make him better so he can return to work. The employee may have other considerations driving his claim. Sometimes knowing what those considerations are is helpful to both sides. Assuming the employee’s considerations are reasonable, the parties may be able to work together effectively so the employee feels his concerns are considered and the employer/insurer feel the claim is moving in the right direction toward closure.

For more tips, please click here to read the article in full.