Insurers and examiners administering workers’ compensation claims
face many challenges with claims involving even minor, non-catastrophic
injuries. The insurer must fulfill its duty to provide the necessary
medical treatment to a claimant injured on a job site while
simultaneously managing the rising costs of medical claims and ensuring a
minor injury-related claim does not advance into a more catastrophic
claim.
Medical claim costs have been steadily increasing over the last several years, according to Verisk Analytics. Many reasons factor in to these rising costs, including advances in medical technology and more complicated issues such as increasingly subjective diagnoses of additional, unrelated medical issues at the time of the workers’ comp incident. Verisk Analytics also highlights growing litigation occurrences and the increasingly complex responsibilities of an insurer’s examiner. As the workers’ comp claims industry becomes more complex, the frequency of claims involving minor injuries developing into more catastrophic injuries may grow if the proper precautions are not taken; these so-called ‘creeping catastrophic claims’ can and should be prevented with the proper claims administration.
The first step in preventing creeping catastrophic claims is to identify instances of these potential cases right away, according to Verisk Analytics. Some workers’ comp claims become unnecessarily complicated or even develop into catastrophic claims due to unwarranted or redundant medical action, overuse of opioid drugs and sometimes even fraud. Even after identifying the early signs of these potential creeping catastrophic claims, proper action must be taken to avoid increased costs and negative outcomes for claimants. Among other suggestions, Verisk Analytics recommends assembling a team and assigning experienced estimators to the claim. This can be difficult for an insurer to do when their examiners are already tasked with many other complex duties and may not have adequate training in areas of medical claims and the pharmaceutical industry or the durable medical equipment, prosthetic and orthotic and medical supply (DMEPOS) industry.
Contact more https://www.northwoodinc.com/preventing-managing-catastrophic-claims/
Medical claim costs have been steadily increasing over the last several years, according to Verisk Analytics. Many reasons factor in to these rising costs, including advances in medical technology and more complicated issues such as increasingly subjective diagnoses of additional, unrelated medical issues at the time of the workers’ comp incident. Verisk Analytics also highlights growing litigation occurrences and the increasingly complex responsibilities of an insurer’s examiner. As the workers’ comp claims industry becomes more complex, the frequency of claims involving minor injuries developing into more catastrophic injuries may grow if the proper precautions are not taken; these so-called ‘creeping catastrophic claims’ can and should be prevented with the proper claims administration.
The first step in preventing creeping catastrophic claims is to identify instances of these potential cases right away, according to Verisk Analytics. Some workers’ comp claims become unnecessarily complicated or even develop into catastrophic claims due to unwarranted or redundant medical action, overuse of opioid drugs and sometimes even fraud. Even after identifying the early signs of these potential creeping catastrophic claims, proper action must be taken to avoid increased costs and negative outcomes for claimants. Among other suggestions, Verisk Analytics recommends assembling a team and assigning experienced estimators to the claim. This can be difficult for an insurer to do when their examiners are already tasked with many other complex duties and may not have adequate training in areas of medical claims and the pharmaceutical industry or the durable medical equipment, prosthetic and orthotic and medical supply (DMEPOS) industry.
Contact more https://www.northwoodinc.com/preventing-managing-catastrophic-claims/
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