29 Jul Claims Uncovered: Part I
This series covers common questions our clients have regarding workers’ compensation claims.
Q&A with Ashley Johnson, Claims Coordinator
How would you describe your job here at VenSure?
For the past 2 years, I have been a Claims Coordinator at VenSure Employer Services. I evaluate, process, and handle the workers’ comp claims for assigned clients. I work with the adjuster, the claimant, and clients to attain the best outcome for each claim. I also update claims, as necessary, answer inquiries, and bring claims toward resolution.
What do you do for fun when you’re not working?
Outside of work, my main passion is horseback riding. I am currently riding an Arabian Gelding and do mostly trail riding in the Arizona desert. When I am not horseback riding, I like to scrapbook and make cards. I love being creative and making things for other people.
Let’s dive into the world of claims and the commonly asked questions you hear from clients…
What is the claims reporting process, and what role does VenSure play in it?
The basic claims reporting process is:
- Our client company submits the required claims reporting forms via fax or email to 480-289-6220 or firstname.lastname@example.org within 24 hours of their knowledge of the injury.
- The claims intake clerk uses the provided information and forms to fill out the First Report of Injury (FROI), a state form which is required in all states when reporting a workers’ comp claim.
- VenSure then submits the claim to Carl Warren and Company within 24-48 hours, as required.
- We do a 3-point-contact. We contact: (1) the employee, (2) the medical provider and (3) the client for any additional information. The 3-point-contact is made within 24 hours of the reported claim.
Who is Carl Warren? How do they relate to our clients, and why is there a 3rd party adjuster working on the claims?
We work with a third party vendor, Carl Warren and Company, to process state forms and issue claimants benefits according to each state’s requirements. We are extremely happy to have an excellent working relationship with Carl Warren.
What claims forms do our clients need to fill out and where can they find them?
Clients can go to the Client Center, located within our website, to download all forms they need to fill out. The Claim Reports Procedures Packet includes the three required forms: the Employee’s Report of Injury, Supervisor’s Report of Injury, and Employer’s Report of Injury. All reports need to be filled out thoroughly. We also have an Accident Investigation form that can be filled out. This is particularly helpful in the event of a severe accident, a questioned claim, or an incident caused by a non-Vensure employee. It is important that all employees sign the Consent for Release of Medical Information. This gives us the leverage to obtain the necessary medical information, especially if the employee goes to a hospital or has had previous injuries that we need to investigate. If there are witnesses, statements should be taken and submitted to VenSure. If the employee provides any medical documents, the medical documents will need to be submitted to email@example.com for proper handling. The more information we have, the better prepared we will be to successfully handle the claim, bringing about the best outcome of the claim.
What if the injured employee does not want to be treated?
If an employee is injured and does not want to be treated, we have a Medical Refusal form that they can sign, declining the treatment. Our client company still needs to submit the claim reports and include the signed refusal to treat. We will then set the claim up as a Report Only and will keep the information on file in the event the employee decides to pursue a claim. An employee can pursue treatment even after signing a medical refusal form. Report Only means that a claim is kept on file and is not reported to the carrier.
What should our client do when they find out an employee has been injured?
In non-emergency cases, our client needs to ensure all required claim reporting forms are completed including the employee form. Next, the employee will be sent to an occupational clinic for medical treatment.
In urgent cases, where the employee needs to be treated at an occupational clinic prior to filling out forms, our client should fill out all of the forms and submit them to VenSure without the employee form to meet our 24 hour claim reporting requirement. The employee will need to complete their required forms as soon as they are able.
In the case of an emergency, the employee may need to be taken to the hospital and will not be in a condition to fill out their form. In this case, VenSure needs to know about the claim immediately. Our client should not wait to fill out the reporting forms. Our client should either call our workers’ comp line at 1-800-409-8958 or send us an email at firstname.lastname@example.org. After a call or email is made notifying us of the claim, the client must submit the reporting forms in order to finalize the report.
What is First Aid? Do clients still have to submit the standard claims reports?
A First Aid claim is a claim that, due to a lack of severity, is reviewed by the Claims Manager and determined to be First Aid eligible. Claims are reviewed on a case by case basis to determine if they are First Aid. First Aid means that the client agrees to pay all of the bills related to the claim. After review, we contact the client to determine if they would like to keep the claim as First Aid. If so, the medical invoices can be reviewed to reduce our client’s out of pocket costs.
Considering all this…
VenSure views our relationship with each client as a team effort. We want to accomplish the same goals as our clients in regard to handling the claim properly, keeping costs down, and bringing the claim towards resolution. Our client can positively affect the claims process, especially at the beginning of the claim, by providing timely claim notification, along with details regarding the incident. VenSure works as a team with the adjusters, the claimants, and our clients to bring about the best outcome of each claim.
Stay tuned for Part II of Claims Uncovered…
In the meantime, should you have any questions regarding the claims process, please contact email@example.com.
Ashley Johnson, Claims Coordinator