Why the Advocacy-based Workers’ Compensation Model Is More Beneficial
The workers’ comp program relies on medical record review to evaluate the injury. The advocacy-based model is the catchphrase in the system now.
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Any firm providing medical record review for attorneys knows how valuable the workers’ compensation program is to employees across the United States, and how keen attorneys are in ensuring that injured workers receive the benefits due to them. Though the program has many perceived benefits, there are some problems within the system. To handle challenges and ensure smooth working of the system, the various states introduce reforms when needed in the areas of medicine, safety, and rehabilitation. Reducing costs and encouraging the injured worker to return to work have always been at the core of reforms introduced from time to time. What Is the Advocacy-based Model? Considering changes that could be beneficial to the system, an advocacy-based model is expected to bring many benefits. This model involves understanding the importance of the injured employee and what their outlook is on a given situation. Some employers have started turning towards this model for their workers’ compensation programs, which can lead to better health outcomes, speedy return to work and less attorney involvement. •
In this workers’ comp model, medical professionals assist and advise injured workers through the compensation process.
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The injured workers are called patients, not “claimants.” Claim examiners and insurance adjusters are called claims representatives.
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A contact point is provided so that injured workers are assisted and heard throughout the process.
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The focus is on ensuring the best care and attention for the patient.
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This helps in avoiding situations such as the employee suing the organization over workers’ comp issues.
How the New Model Works When a worker is injured while on the job, she is immediately connected to a medical professional such as a triage nurse. In the advocacy-based model, the worker’s health is of prime importance. If a medical professional can be at hand for providing the necessary first-aid or treatment, or medical advice, they may be able to prevent a more serious situation or condition from developing. If medical treatment is necessary, the triage nurse or other staff assigned can help the injured employee locate physicians and schedule appointments. This will help to take a huge burden off the employees. Observers in the field stress the importance of “empathy” in an advocacy-based workers’ comp model. Empathy or compassion can go a long way in helping to establish communication with the employee. Instead of mechanically making a diagnosis and
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explaining it, it is important to ensure that you really communicate with the worker and show them you care about their recovery. Supervisors and other employees also need to be trained regarding how to interact with injured workers. Another reason why empathy is needed is because these workers may have other problems as well, such as domestic issues and ill health of their near and dear ones that could affect their recovery. Establishing expectations is an important element in the advocacy-based model. What does this mean? Injured workers must be told about what their recovery will entail, and who to contact in case a check comes late. In the absence of this knowledge and resultant confusion, there is more chance of litigation and higher costs. Thus ongoing communication with the injured worker is indispensable. The employee must be contacted regularly, and given reassurance. She must also be told how the organization is looking forward to having her back on the job. Appropriate answers should be given in case the employee has any questions or concerns regarding the claim process. Injured workers who feel that their employers really care about them and are willing to work with them feel valued and empowered, and are more likely to return to work. They are less likely to feel frustrated or confused, and will have a better understanding of the way the workers’ comp system works.
Points to Consider When Implementing Advocacy-based Workers’ Comp The advocacy-based model may be easier for large organizations/employers to implement. However, regardless of the size of the organization, the advocacy-based model can be implemented taking into account the following factors. •
Address the medical needs of the injured worker immediately. This will help to avoid claims later on. This can be done with the support of a good injury triage provider.
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Provide the necessary information to the worker. Employers can have a medical person explain the medical processes involved. Other information to provide include how the process works, what to expect, whom to contact, and what the worker can do to help the process along.
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Ensure regular communication with the injured worker. The worker should be contacted regularly and enquiries made about how the claim process is progressing.
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Make the entire process as simple as possible. Injury reporting can be made quick and easy via the organization’s website or a mobile app. In this way, the injured
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worker need not waste time trying to find out whom to report to and what steps to take following the injury. The advocacy-based model is advantageous in that attention is focused on the injured worker and his/her well-being. The focus is shifted from the usual complexities of claim handling processes. Outsourced advocacy services are available, though observers are divided regarding the outsourced model. It is expected that this new model could reduce litigation rates, reduce the number of claims filed, improve return-to-work rates, and enhance injured workers’ satisfaction.
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