RED FLAGS IN WORKERS’ COMPENSATION CASES
By: Steven Babitsky, Esq.
What do workers’ compensation case managers and other professionals look for to identify claims that are likely to be difficult to resolve? Workers’ compensation “red flags” may be the most efficient and cost-effective way to identify these claims early on in the management of these claims.
These red flags include:
- Employee claims unable to work, although fully recovered and released to RTW by physician
- Received more medical care than usually required
- No objective medical substantiation of injury
- Disgruntled employee
- Employee recently disciplined
- Employee faces job insecurity (layoffs)
- Disability is acceptable lifestyle
- No witness to injury
- Injured last day of shift or first day of shift
- Injury the day prior to school holidays, ex. Thanksgiving, Christmas, NYD, spring break and/or end of school for the summer.
- Treating doctor known for suspect claims
- Doctor shopping for agreement with claimant
- Only treats with a Chiropractor
- Substantial gaps in medical treatment
- Refusal of doctor to release to restricted duty
- Medical treatment inconsistent with injury
Sharon Kemerer MSN, COHN-S/CM, RN will be presenting Case Management Systems: Using Multi-Strategies to Optimize Results at the SEAK 33rd Annual National Workers’ Compensation and Occupational Medicine Conference to be held on July16-18, 2013 on Cape Cod, MA.
Ms. Kemerer will discuss the full range of strategies used at Baxter to manage workers compensation for its approximately 20,000 US employees. She will explain the use of metrics to define and track program status and the effective use of internal and external partnerships with risk management, TPAs, brokers, and legal. Other strategies including effective reporting tools, early claim identification mechanisms, large claim reviews, joint claim handling audits, building internal expertise and cost savings capture have resulted in savings of over $ 8 MM in the past 5 years. Ms. Kemerer will offer practical cost-effective suggestions for optimizing case management results.
Sharon Kemerer MSN, COHN-S/CM, RN is corporate director, Occupational Health and Safety for Baxter Healthcare Corporation with 20,000 US employees and over 85 occupational health professionals globally. Ms. Kemerer has had extensive experience in occupational health and safety program design and management, training and case management. She is a Fellow of AAOHN and former executive director of the ABOHN. She received her MSN from the Loyola University and her BSN from the University of Illinois at Chicago. She is certified in occupational health and case management.
For additional information about the SEAK National Workers’ Compensation and Occupational Medicine Conference
Steven Babitsky is the conference leader.