Skip to main content

Lost Time vs. Medical Only Workers’ Compensation Claims

By February 15, 2022May 4th, 2022No Comments

No matter how many safety precautions are taken, an on-the-job injury can still happen. That is why there are called accidents. Such incidents can result in workers’ compensation claims, which can vary in nature based on the circumstances and severity of the injury. Whether a claim is defined as “Medical Only” or “Lost Time,” both will impact an organization’s bottom line.

What is a Medical Only Claim?

These are claims in which an injury sustained by an employee requires attention from a healthcare provider. In this case, the employee is released back to work after being treated. Even if an injured worker returns to modified duty, the claim remains Medical Only, as they can return to work without taking time off related to their injury.

What is a Lost Time Claim?

These types of claims involve an injury with severity that warrants a healthcare provider to restrict the injured employer from returning to their job for a specified period of time. They are also the more expensive of the two types of claims. When an employee cannot return to work due to their injury, this disruption in productivity costs an organization profitability. That is an added expense in addition to paying out workers’ compensation benefits. Lost Time claims can also impact the mod factor and loss ratios, both of which can result in higher insurance premiums.

Prevent a Medical Only from Becoming a Lost Time Claim

A claim may start off as a Medical Only claim, but employers can be caught off guard when they turn into a Lost Time claim. There are ways to prevent this escalation:

  • Send Injured Workers to Approved Medical Providers – The majority of the time, if not given specific guidance, injured employees will schedule a visit with their primary care physician following an on-the-job injury. Most family doctors, however, aren’t going to be familiarized with return-to-work or light/modified duty programs that your organization may offer employees. Without the knowledge of such programs, they may opt to restrict an employee entirely, not realizing there are alternatives that would allow them to return reasonably and safely to work sooner. Sending injured employees to pre-screened and approved physicians who advocate for return-to-work and modified duty programs is in the best interest of the employee and employer.
  • Immediately Notify Claims Adjusters of Potential Fraud – Unfortunately, there are instances where an on-the-job incident and subsequent injury may seem suspicious to employers. In these scenarios, it’s important to communicate any such concerns to your claims adjuster right away. The sooner an investigation begins, the sooner a fraudulent claim can be cut off before escalating into Lost Time.
  • Treat All Claims Equally – Even if a claim seems suspicious or less severe, it’s critical to approach every claim the same way. At times even a seemingly minor injury can quickly spiral and become far more severe than anticipated. Quality and prompt medical attention is critical for all injuries. A broken bone may seem more severe than a laceration… until an infection leads to an amputation. Don’t ignore or dismiss any injury, no matter how big or small.
  • Support Injured Employees – Employers with a “tough it out” attitude are setting themselves up for a slew of Lost Time claims. Don’t discourage employees from seeking medical treatment. As mentioned before, even small injuries can escalate to bigger ones. In addition to that, though, fostering a culture where safety and employee well-being are valued promotes a better morale for your team, where everyone feels that they matter.

Members of Hearten Workers’ Compensation benefit from working directly with industry experts to proactively handle claims. That means getting employees back to work faster after injuries, keeping premium rates stable and businesses running more efficiently. Hearten members also have access to peers in their industry, meaning they are afforded insight from other best-in-class organizations on how to manage and prevent similar claims, especially those unique to human and social services.




Skip to content