WORKERS’ COMPENSATION CLAIMS SPECIALIST 14-DAY CHECKLIST Initial File Collaboration Explanation Coverage Confirm coverage, employee and state is covered. In-force- Policy? Use your C3 policy search. Timely Initial Contacts – 3 Point If cannot make contacts, contact leader. MISSED CONTACT IS UNACCEPTABLE. Review Initial Investigation/Employer Confirmation of accident, injury and body part, witnesses, recorded statements, advise employer to stay in contact with employee. REQUEST WAGES AND JOB DESCRIPTION. Check injury codes, etc. for accuracy. Contact W/Provider If able, confirm description of injury/accident given, body part, last and next appt, and work status Contact W/Employee Recorded statement, confirm accident description, confirm lost time dates, confirm all body parts injured, last appt and next appt, explain expectations/benefits, document a profile, discuss RTW expectations and prior injuries Subrogation Referral Is there recovery potential? Jurisdiction Verify Class Code Verify Confirm Work Comp Type Mo/Ind. This should be changed on the summary screen. Compensability Decision Agree? Need any further investigation? Document. Losing Time? MARK FILE Medical Records Requested? Work Status Received/Confirmed RTW Screens Complete First Pay Due Date? Document file. Wage Statement Received? Benefits Calculated Correctly And Documented? Job Description Requested From Employer Job Description Sent To Provider Medical Treatment Plan/Fill In RTW Projection Form May not need or be able to use Surgery Form May not need or be able to use Need for SIU? Nurse Case Management Needed? Medicare? HICN ORM Assumption Completed? ISO Should be sent by outbound team. Initial Reserves Must outline most probable outcome Form Work Completed the initial form work? Be specific when needed. Reserving appropriate? Following handling instructions and do reserves accurately reflect exposure? Pay attention to initial reserves, ensuring it reflects exposure. 10 11