Lessons Learned: Long-Term Care

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The Claim

In a recent case, we had a claimant that hit his head on a piece of metal. The initial injury was a cut that was bleeding. After reporting it to his supervisor, he had two seizures. Paramedics were called to the scene and he was transported to the hospital. Once he was released, the employer terminated his employment. The claimant continued to seek treatment and suffered further seizures. The incident was not reported to LCI until nine months after the incident date. We received notice of it from his attorney, and the claimant is still unable to work. Not only do we owe back medical and indemnity payments, we now will be fined for late payments in both areas.

 

What could have been done?

If LCI were aware of the claim, we would have made sure the claimant had the proper medical treatment and paid his ongoing benefits. We would have worked with the claimant and made sure he felt we were taking care of his needs. Also, LCI lost its ability to properly investigate the claim and get second opinions on the claimant’s treatment in the early stages of the claim. The longer a claim goes without proper handling, the more it will cost in the long run. The claimant obtained an attorney and filed suit because no one was working with him. Generally, the cost of a claim at least doubles once there is a suit filed because we lose our ability to work with the claimant.

How does LCI handle claims?

With our claims experience, relationships with vendors in the healthcare industry, and continued communication with the employer and the injured worker, we ensure that injured workers receive appropriate treatment from the onset. Our involvement greatly reduces the risk of a claim becoming more costly by controlling the medical costs and keeping the claimants from obtaining legal representation. And contrary to popular belief, just because you have claims doesn’t mean your rates will go up, there’s a lot more to it than that.

 

For Next Time

Regardless of the severity, I encourage you to call our department any time a worker is injured. Our claims staff will explain the process, answer any questions you have, and give you options for next steps. We can keep the claim as an RPO, and if it becomes more costly, we can pick up the bills. The more we know, the better we can serve you. Our friendly and responsive staff stands ready to help answer any questions.

Contact the Claims Department by calling (888) 246-1988 or by emailing claims@lciwc. For more information, see lciwc.com/claims.

Originally published on LCI Wokers’ Comp.