Breaking the Code

Even the best loss-prevention program cannot prevent all losses. Often an area that is less of a risk-management priority is injury management. In previous posts, I have discussed the importance of selecting healthcare providers who are specifically trained to treat work-related injuries.

Assuming you have found a physician who is board certified in occupational and environmental medicine, is this a guarantee that your injured employee is back to work at the right time? Not necessarily. Managing the impact of employee injuries on your profit and shareholder equity goes much deeper than finding the right healthcare team.

What medical guidelines does the provider follow? Will your injured worker return to work in the right amount of time? What diagnosis code was used to classify your employee’s injury? Every bill submitted to your workers’ compensation (WC) claims representative must contain this code for you to receive payment.

The diagnosis code not only identifies the injury, but it also contains ranges regarding the recovery time for injuries. For example, knowing the code will help you determine whether your worker who has been out on disability with an ankle injury for three weeks is receiving the right treatment and oversight. Through resources such as you can find the range of time for when that employee should be back to work. Does the diagnosis code indicate the employee with the ankle injury should have been back to work in one week?

Why does this matter? Because for every day of lost wages paid by your insurance carrier, your WC costs are increasing. It is imperative to have someone on your team working with your carrier and adjusters to be sure the period of time that an injured employee is out falls within the range of time that is medically acceptable.

Your Experience Modification Rating increases as the amount of lost wages paid to your injured workers increases. This drives up your premium for three years in a row. So who is managing this important injury management component for you? Is it your risk manager or your insurance agent? Hopefully, someone is discussing this information with your WC adjuster for every claim where an injured employee is out of work. If not, the horse is out of the barn and you will be the victim of runaway WC expenses.