WC Magazine

FEB-MAR 2016

WC is published six time a year and covers the trends and topics of interest to professionals responsible for the cost-effective resolution of workers’ compensation claims.

Issue link: http://theclm.wcmagazine.epubxp.com/i/655843

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Page 29 of 43

30 WC February 2016 | March 2016 TheCLM.org The Forum Answering the Question, "Why Do Claims Stagnate?" I In each issue of WC maga- zine, we gather a cross-section of the sharpest minds in the workers' compensation community and press them with questions on matters that afect the industry. In its inaugural edition, Te Forum looks for answers on why some workers' compensation claims take so long to resolve and what the major players can do to fx the problems. Richard Lenkov: Let's jump right in. Why does it take some cases so long to go from claim to reso- lution? Jason Whiteside: Medical treat- ment takes too long to get approved. Te most successful resolution of cases is when treatment is approved, it's concise, and it's short in duration. Tere ofen are delays with independent medical exams and surgery approval, too, which further increases recovery time. James Poerio: Workers' compen- sation claims evolve due to changes in claimants' medical conditions, appro- priate diagnoses, and disagreements as to the appropriate treatment. Having an accurate grasp on what the medical conditions are and what treatments are necessary ofen is difcult and can impede ultimate resolution. Michael Mattix: No one is paying sufcient attention to the end result, which should be returning the injured employee to gainful employment or achieving a just and reasonable settle- ment of the claim. Tis lack of focus serves no one well. Te employer is deprived of a valuable employee, its workers' compensation costs go up, and the employee is deprived of earning full wages. Lenkov: From a defense attor- ney's perspective, what are some reasons that cases stagnate? Poerio: Cases stagnate if a claimant who is receiving benefts is not closely monitored for return to work and if the employer is unable or unwilling to accommodate modifed duty. Ideally, an employer is willing and able to accom- modate restricted and modifed duty with real, meaningful work. If that does not occur, the other options available to an employer are time-consuming and expensive. Lenkov: Mike, same question but give us the claims perspective. Mattix: Tere are several reasons why cases can stagnate. Te frst is the idea that "too many cooks spoil the broth." Tis happens when just about every function related to case manage- ment, bill review, legal services, and job placement is outsourced. It is easy to lose track of what steps to take next. Sec- ond, we're ofen forced to "major in the minors." Jurisdictional requirements and protocols ensure that claims profession- als focus on unimportant details rather than the ultimate goal of returning the injured worker to his job or to settling his claim. Tird is what I call "waiting for Godot." Claims professionals are taught not to negotiate without a demand. Why is this? If you know what your claim is worth, take the initiative and begin ne- gotiations. In too many cases, the carrier continues to pay additional indemnity and medical benefts (not to mention in- curring additional claims expenses), yet the value of the case remains the same. Richard Lenkov, Capital Member, Bryce Downey & Lenkov LLC Rich's practice areas include, among others, insurance litigation and workers' com- pensation. He has nearly 20 years of experience achiev- ing successful outcomes for his clients, and serves as co-chair of CLM's Workers' Compensation Committee. Moderator

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