Guide to Claims Handling

1. Guide to Claims Handling Presented by: Jason Trujillo, Senior Claim Representative

2. Items that help with questionable claims: • Extensive claim investigation • Clear, concise, and timely witness statements • Pictures • Timely notification toPinnacol • Previous medical history • Key into employees that know the injured worker.

3. What are some services that can help with investigation? • Surveillance • Insurance Index • Perform hospital and/or pharmacy searches • Write letters to the treating doctors to address concerns

4. Continued… • Request independent medical examinations • Speak directly with treating providers (Only if the injured worker is not represented) • Request medical history from the injured worker.

5. What can our policy holder do to help control the claim costs? • Focus on accident investigation • Early claim reporting • RTW and Safety Program • Open communication with the claims representative, medical providers and injured worker.

6. What are some signs that indicate permanency or delayed recovery? • At least 6 months of medical treatment with no improvement • Surgery • Functional Capacity Evaluation • Injured worker is not cooperating

7. How does your provider respond to questionable cases? • Key phrases in medical reports • Review and respond to surveillance video and letters • Review independent medical examinations

8. How do claimant attorneys effect the cost of the claim? • Increased impairment ratings due to the injured worker going through the DIME process • Increased medical costs • Legalexpenses for litigation on issues

9. Tying it All Together • If we all work together we can make sure that workers’ comp claims are handled efficiently and appropriately. • Questions