Workers Compensation & Claims Handling
Background
While all claims situations are serious, workers compensation claims are particularly harrowing because they involve the most valuable resource a business has: its people. The timely handling of a workers compensation claim can have a huge impact on the ultimate outcome. Cases that do not receive proper attention in a timely fashion — both from an indemnity perspective and a medical perspective — have the potential for a poor outcome. As such, any steps that can be taken to move the process along quickly are much more likely to create the best possible outcome.
Situation
On Oct. 25, 2007, Society Insurance received a First Report of Injury via fax. The form indicated that an employee had fallen into a 680-degree Fahrenheit tank on Oct. 24. The injured worker was then airlifted to the University of Wisconsin Hospital as a result of severe burns to his arms and legs.
The worker was hospitalized in the burn unit in critical condition with third-degree burns running from his thighs all the way down to his feet, and with second- and third-degree burns on his lower arms and elbows.
Society Insurance Solution
The claim was immediately assigned to a seasoned adjuster with experience in dealing with these types of serious claims. This adjuster quickly gathered the facts of the case and spoke with the injured worker’s mother—the worker was unable to speak because of his condition—at 10:33 a.m. on Oct. 25, 2007.
Just 23 minutes later, Society’s in-house telephonic nurse case manager contacted the Burn Center in order to obtain information regarding the extent of the injured worker’s injuries and to let the hospital know of Society’s involvement with the case.
In this case, Society determined that a field nurse case manager was necessary to ensure that the injured worker was getting the appropriate care and attention needed. The nurse case manager was also assigned to keep Society apprised of any new developments with the condition of the injured worker.
As Society’s in-house telephonic nurse case manager spoke to the Burn Center, Society’s adjuster was meeting with the insured. Prompt investigation of the scene is critical for an adjuster to ensure that any evidence is not tampered with. The adjuster examined the vat and took numerous pictures of it and the surrounding area. Through a careful line of questioning, the adjuster determined that subrogation was not possible in this case.
On Oct. 26, the adjuster and the vice president of workers compensation at Society phoned an outside medical vendor that assists insurance companies with catastrophic cases to discuss the situation and any future handling that might be required. The vendor offered advice and guidance in an attempt to ensure a good claim outcome.
While Society did receive a Letter of Representation from the injured worker’s attorney, that was not a surprise and not unusual for a catastrophic case—people are justifiably worried about their future and want to ensure the best outcome for themselves.
However, because all benefits owed were conceded on a consistent and timely basis, the attorney had no further role to play in the incident. Although the injured worker had a long recovery, he healed uneventfully and was able to return to work with no subsequent wage loss.
Society works with all its policyholders to investigate the details of accidents in the pursuit of the best possible outcome for everyone involved. Society’s team of claims experts makes a big difference through extensive experience and top-notch service. To find out how Society can help you, visit societyinsurance.com to find an agent and request a free quote.