Workers’ Compensation Claims Handling Guidelines • The Workers' Compensation Claim Specialist is responsible for using case management tools, when needed, to assist in the medical management of the injured worker. The Workers' Compensation Claim Specialist must request approval from the Unit Manager for all Nurse Case Management assignments and further approval from the client, where necessary. Disability Management - Modified Duty/Return to Work: • During the initial investigation of a lost time claim, the Workers' Compensation Claim Specialist should verify whether the employer is willing to accommodate modified duty. If so, the Workers' Compensation Claim Specialist should advise the treating physician early on and reiterate requests for release to return to work. o The Workers' Compensation Claim Specialist must have a detailed disability plan documented in the file, including projected and full-duty RTW target dates. o The Workers' Compensation Claim Specialist must complete the Work & Benefits Section of the tree with the appropriate disability information. • When the Workers' Compensation Claim Specialist becomes aware that an injured worker has been or is about to be released to modified duty, the employer should be contacted to determine if modified duty is available within the injured worker's capabilities. If the employer cannot provide modified duty, other options should be considered, including but not limited to third-party strategic partners. • If lost time is excessive for the type of injury and the treatment is prolonged unnecessarily, the Workers' Compensation Claim Specialist should consider a second-opinion evaluation. • Indemnity Payments: The Workers' Compensation Claim Specialist must issue all indemnity benefit payments in accordance with the applicable statutory guidelines. The Workers' Compensation Claim Specialist shall utilize all system-generated benefit rule details and must validate such benefits at the time of payment. • Any late payments of initial or ongoing indemnity must be documented in the file and communicated with the injured worker, Unit Manager, and Director. • The Workers' Compensation Claim Specialist may establish recurring payments scheduled for the minimum number of weeks of the expected disability period but may not exceed the following: o Non-surgical disability claims; up to 6 weeks o Surgical disability claims; up to 24 weeks o Permanent disability: may be scheduled for up to 52 weeks or for the entire benefit period, whichever is less o Fatality; may be scheduled for the entire due benefit period This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.