Paul Mcknigth

Eastern Alliance Insurance Group Review - Already Have a Claim?

Posted in Insurance

Many employers have questions about what happens after they report a claim. You may also wonder how an ecovery program fits into the claims process.

 

1.      The claim is reported to Eastern and assigned to a Claim Representative. Prompt reporting is very important to the process! Your claim should be reported immediately so that Eastern can begin managing it appropriately.

 

2.      The injured worker seeks medical attention and treatment begins; if you have a medical provider panel in place, you may need to have the employee sign an acknowledgement form prior to treatment (except in an emergency situation). Physicians should be informed that the injury is work-related and that you have a Return to Wellness (RTW) program. This way, the treatment plan can be tailored with the goal of restoring productivity and a return to the workplace. All medical bills should be submitted for Eastern’s review.

 

3.      Eastern initiates a 3-point claim investigation, contacting the injured worker, the employer and the medical provider. This investigation will result in an approval or denial of the claim. Regular contact among all three parties is encouraged and plays an integral role in a successful outcome.

 

4.      Eastern obtains wage information to determine the amount of weekly wage benefits the injured worker will receive.

 

5.      Reserves are developed based on disability and medical diagnosis, treatment plan and your ability to offer modified duty.

 

6.      Eastern investigates any viable subrogation possibilities.

 

7.      The medical provider addresses the injured worker’s ability to work by reviewing your pre-injury job description and proposed modified duty job description.

 

8.      You should then utilize the ecovery modified duty task lists and the restrictions provided by the treating physician to develop a modified duty job offer.

 

9.      The injured worker returns to the workplace, performing modified duty within the physician’s restrictions.

 

10.  The injured worker continues to recover, receiving the physical, financial and psychological benefits of returning to modified duty. Additional medical treatment continues, as appropriate, and the treating physician periodically re-evaluates the injured worker’s work capabilities.

 

11.  Your designated Risk Management Consultant reviews the accident information and will make recommendations to prevent future injuries.

 

12.  The injured worker is either eventually released to his/her pre-injury job without restrictions, or is given permanent restrictions. The outcome is influenced by a variety of factors, including jurisdiction, job availability, the individual details of the claim, and other considerations.

 

13.  Any additional benefits due are paid and the claim is brought to resolution.

ecovery’s Return to Wellness philosophy is linked to every step of a claim! Modified duty options should be consistently re-evaluated and monitored to achieve the best possible outcome for all parties.

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4:38 AM - 2/20/2017


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