Last updated: May 29, 2023
Catastrophic workers’ comp insurance claims rank in at one percent of all claims filed. However, they also account for a whopping 20% of the total Workers’ Compensation losses overall.
That is mind-boggling.
Small statistic, but underestimated
No one has “have a catastrophic accident at work” on the list of things to do.
Sadly, though, it happens.
A catastrophic Workers Comp claim falls under one of the following:
- burn injuries
- head injuries
- spinal cord injuries
- multiple trauma injuries
These cases require major medical care that often lasts a person’s lifetime.
The ultimate cost incurred from a catastrophic claim is hard to predict at the onset of the case. In fact, they often go over the original estimated cost of the claim. Conversely, it is rare if annual medical payments on these claims are under $100,000. In addition, the ever-rising cost of medical care throws a curve into the mix.
Subsequently, insurance providers count on the fact that all parties involved in determining the cost-factor are on top of their game.
Playing our part
Those who support the claims managers in this process play an important part in establishing the details that help determine the final projection costs. In order to process the claim correctly, they need to discover a cause.
First of all, the claims manager determines if the employee was impaired. Were drugs or alcohol involved? The drug testing process provides the claims manager the information needed to get things rolling.
Six small steps
The collector’s job is to ensure whether or not the injured worker was drug-free at the time of the accident. This enables the claim manager to determine which company protocol to follow from that point forward. This is where post-accident drug testing comes in.
Collectors make a huge difference in the outcome of the claim.
The specimen should be collected from the injured worker as near the time of the accident as possible. As a matter of fact, the closer to the actual time of the accident that the sample is taken, the more likely that it can link with the accident. Claims managers are in the best position if they collect a specimen within 24-hours.
If it isn’t possible for that scenario to play out, contact your legal counsel to obtain a preservation order. Hospitals have samples that were drawn when the employee was admitted. This order requires that the hospital laboratory releases them for testing.
The claims manager shares the necessary information with the collector. Providing name, ID number, Social Security number, date of birth, and a company contact name ensures positive identification.
In the event that a preservation order was necessary, the collector contacting the hospital uses this information to request a specimen from the hospital’s initial sample.
It’s beneficial to obtain a copy of the employee’s signature accepting the drug-free workplace policy from their personnel file. Hospital staff or risk management often require this document before proceeding with the collection request.
Time is of the essence
All things considered, it is helpful for the collector to have the exact date and time of the accident. This allows them to meet the time constraints that exist.
Point of contact
It’s best if one person is in charge of handling any communication regarding the claim. The claims manager is usually the primary point of contact but not always. Taking the time to ascertain the point of contact is a wise choice. It alleviates chances of miscommunication. This saves time.
The hospital usually requires two court orders. One order calls for release of the specimen. The second order releases the specimen to the collector. Your legal counsel is prepared for that.
Hospitals discard their laboratory specimens days after collecting them. In some cases, the hospital discards samples after 48 hours! Consequently, act immediately to request a court order.
In the event that a preservation order is necessary, it’s important to note that either legal counsel or the selected collection company works with the hospital’s laboratory management. Together, they determine the type and volume needed for the drug test. Determining a valid result depends on the lab receiving a minimum quantity. This is the case whether blood, saliva, or urine determines the result.
The road less traveled
Catastrophic Workers’ Comp claims account for a small percentage of the claims submitted each year. At the same time, every claim indicates someone’s life drastically changed.
If the employee involved in the accident is drug-free, it impacts their claim in a positive manner. In contrast, a positive result works to a negative degree.
Let’s always hope for a negative result.