Workers’ Compensation Quality Claim Review Expectations The NARS Way – Team Leader - Quality Claim Review Expectations Contacts Prompt contact is an essential part of good customer service and proper claims handling. From the limited information provided on the First Report of Injury, Workers’ Compensation Claim specialists can expand their understanding of the events surrounding the accident during this initial voice to voice contacts. With timely voice to voice contact within a short period of time after the receipt of the claim, the claim specialist can obtain a sense of the employee’s injuries arising out of and in the course of their employment. During this initial contact, the claim specialist needs to fully explain the applicable Workers’ Compensation benefits to the injured employee and the claim specialist role throughout the process. This should place the employee at ease, knowing (and understanding) what benefits are provided to address the financial exposure of the incurred medical expenses and loss of potential wages. Explanation of other benefits, such as mileage, should also be explained. Questions to ask yourself while reviewing for contacts: • Was contact made with the employer within 8 hours on the date the claim was reported? • Was contact made with the injured worker on the date the claim was assigned or within 8 hours of receipt? • Were initial contact efforts timely? (One time per day: hourly is excessive…four days is too much) • Were benefits and the claims process properly explained to the injured worker? • Were follow-up contacts appropriate? Suggested recommendations for improvement with contacts: • Attempt to make voice to voice contact with the employer and the injured worker on the same day the claim is reported. If the initial attempt is unsuccessful, try again the next day and include a text and/or email. • Establish an activity for timely follow up of the initial attempt and subsequent contacts. • Document all contact attempts in the claim file either the day it is accomplished or the next day. Do not allow days or weeks to pass prior to documenting contacts. • Regarding reassigned claims, have the claim specialist contact the injured worker and the employer within three days. Communication • Did the specialist communicate with the injured worker monthly while off work? • Did the specialist communicate with the injured worker to discuss significant changes, throughout the life of the claim? • Did the specialist communicate with the employer to discuss significant changes, throughout the life of the claim? • Did the specialist send a card or flowers during the life of the claim, when applicable? NARS’ Best Practices were created by and for the internal use of NARS and are confidential, proprietary and trade secret documents protected by the Uniform Trade Secrets Act and applicable state/federal law. They may not be copied, distributed, or reproduced, in whole or in part, without NARS’ express prior written authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.