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Lost Time vs. Medical Only Workers’ Compensation Claims

By April 29, 2020 May 6th, 2020 No Comments

Workers’ compensation claims can vary in nature based on the circumstances and injuries resulting from an on-the-job incident. There are clear differences between Lost Time and Medical Only claims, and they both impact your bottom line.

Definitions

  • Medical Only – Claims in which an injury sustained requires attention from a healthcare provider. In this case, the employee is released back to work after being treated by the medical professional for their injury. A claim remains Medical Only if the injured worker returns to modified duty prior to the elimination period lapsing.
  • Lost Time – Claims in which the severity of an injury warrants a healthcare provider to restrict the employee from their regular job duties for a specified period of time. These types of claims can impact a mod factor and loss ratio, which can result in higher insurance premiums.

Not that employers want any injuries and their subsequent workers’ compensation claims, but accidents are bound to happen from time to time. It’s in the employer’s best interest to limit their Lost Time claims. Lost Time claims means an injured employee physically cannot perform their regular duties. That can cause a disruption in your company’s productivity and profitability on top of the need to pay out workers’ compensation benefits.

Sometimes, even Medical Only claims can become Lost Time claims. Employers can be caught off guard when this happens. However, this can be prevented in a variety of ways:

  • Send Injured Workers to Approved Medical Providers – Statistics show that most injured employees will visit their family doctor after an incident and not all general physicians are going to be familiarized with any return-to-work or light/modified duty programs you may have. Because of this, they may restrict work entirely, not knowing that there are reasonable ways to get the injured employee back to work sooner. Send injured employees to pre-screened and approved physicians who advocate for return-to-work and modified duty programs.
  • Immediately Notify Adjusters of Potential Fraud – Unfortunately there are accidents that may seem suspicious to employers. In this case, it’s important to communicate any concerns to your adjuster immediately. The sooner an investigation begins, the sooner a fraudulent claim can be cut off before becoming Lost Time.
  • Treat all Claims Equally – There are times when seemingly minor injuries can spiral and become far more severe than anticipated. Quality and prompt medical attention is critical for all injuries. Don’t ignore or dismiss any injury, because any injury can quickly become a Lost Time claim if not handled properly.
  • Support Injured Employees – Employers who maintain a “tough it out” attitude can set themselves up for a slew of Lost Time claims. Don’t discourage employees from seeking medical treatment, even if an injury is minor. Without proper medical attention and recovery time, even mild injuries can become severe and result in complications.

Members of workers’ compensation captives like Hearten benefit from working directly with experts to proactively handle claims. This means getting employees back to work faster after injuries, which in turn keeps premium rates stable and your business more efficient. 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 their industry.