EMR- Reduce claim cost.
Employers can influence Experience Modification Rates (EMR) for the better, in many ways. Once an injury has occurred, the response and investigation can play a vital role in reducing the cost of the claim.
First and foremost, take care of the injured employee and their injury. Ensure the case is triaged properly and the employee receives the appropriate level of care, promptly and at the appropriate facility. It is important to have a network of vetted occupational health facilities. A relationship should be established with the occupational health providers in advance.
Investigating the incident and providing accurate information to the Workman’s Compensation carrier can paint a picture of what occurred and aid the adjuster in making decisions about the claims. The investigation should seek to determine if, and how, the event occurred in the workplace. It should also be considered if the mechanism of injury (MOI) correlates with the injury. Other important information to provide the adjuster includes the length of employment, recent disciplinary issues, witnesses, or the lack of witnesses, photos, and video. The carrier will also need to know when and how the company learned of the reported injury, as compared to the incident occurrence time. If there was a delay in reporting the injury, why was there a delay? What was the employee doing between the time of the injury and reporting it to the employer?
After a proper response to the injury by the employer and equipped with complete and accurate information, the claims adjuster can make better decisions. They may be able to deny the claim if they believe it is not a valid claim or covered event. In the case of covered claims, they can make a quicker decision to accept the claim and move forward with treatment more rapidly. Adjusters must weigh the cost of covering the claim, against the cost of litigation. In many cases, I have seen them cover the initial visit cost, so the employee was not responsible for that expense but then denied any future coverage. This can often resolve the case to everyone's satisfaction, and lower claim cost.
This is my opinion, based on lessons I have learned and some successes I have experienced. It is not legal advice, as I am not a lawyer, nor am I an insurance professional. I had to learn the hard way and figure it out. In the next few weeks, I will share more details and opinions.
