Understanding Claims Management in EHS

Countless aspects go into the management of environment, health, and safety (EHS) in the workplace. Claims management is one such aspect that factors into EHS but can sometimes get overlooked.

Needless to say, not paying attention to claims management can be an issue that can cost companies in more ways than one. To help rectify that, let’s take a close look at how businesses can better understand claims management, especially in the context of EHS and employee safety. 

Address Injuries Quickly 

As a precursor to proper claims management, companies must be able to assess and address injuries quickly. Ideally, there will be employees who are certified in first-aid and have a system in place for how to address injuries, especially in emergency situations. Of course, during an emergency, it’s easy to provide treatment as quickly as possible. With long-term injuries or lingering pain, it can be a little more complicated. Also, a lot of companies make the mistake of waiting to see what will happen rather than being proactive.  

The sooner someone can get a diagnosis and start receiving treatment, the better. It’s not just better for that individual but it can also help to reduce the timeframe of a claim, not to mention the seriousness of that claim. However, to accomplish this, employers need to make it clear to workers that they want to know about and address all instances of pain and discomfort rather than wait for things to become more serious. This isn’t always an easy stance for companies to take, but in the long run, it should help simplify claims management while also being what’s best for the health of the employee. 

Clear Reporting Policy 

Part of encouraging employees to come forward with minor aches and pains rather than waiting for them to become serious is having a clear reporting policy in place. Both employees and their supervisors need to know the process of reporting accidents and injuries in the workplace. It shouldn’t matter how big or small the accident is, everything should be reported. There also needs to be a universal way for how information should be collected for accident and injury reports.  

This level is consistency is critical with claims management. Companies need to make sure that all of the pertinent information during the claims process has been properly collected and recorded. This becomes much easier when there is a clear reporting policy in place that everyone in the company knows about and is able to follow. If the policy is in place and is clear to everyone, it’s more likely that employees with an injury will come forward sooner, helping to simplify the claims process. 

Standardize Everything 

Along those lines, everything must be standardized to help create a consistent claims process. Companies that are successful in claims management usually have a standardized process that’s been in place for a long time. Every step of the process is planned out, meaning that most claims involve simply filling in the blank spaces. For example, the way information and evidence for claims are collected should be the same every time.  

The process of getting injured employees medical treatment should be the same every time. The same is true for how company leaders and employees communicate during this process and create a plan for when an employee returns to work. Obviously, no two claims processes are exactly the same. But it’s amazing how smooth the process can be the structure of claims management is standardized as much as possible. 

Utilize Trusted Medical Providers 

Trust is one of the biggest keys in claims management. To some extent, trust is created by having a clear policy and a standardized process. However, employers also need to make sure they are utilizing trusted medical providers during the process. Employees who get hurt during an accident or are nursing a long-term injury shouldn’t be going to just any doctor. Companies need to have a general practitioner and a team of specialists in mind that they know are trustworthy. If certain types of injuries are more common, it should be easier to find specialists who can treat that type of injury. 

The right medical provider will be able to see patients as soon as possible and be trusted to provide an accurate diagnosis. If there is a delay in treatment or the diagnosis is wrong, the claims process can drag on, becoming overly complicated and expensive. It’s sometimes appropriate for companies to move on from medical providers who do something to show that they aren’t trustworthy. If something doesn’t feel right or things are taking too long, it’s okay to find another medical provider. Ideally, employers will be able to find a set of medical providers who can be trusted because this can make a huge difference when it comes to the claims process. 

Put Other Vendors on Your Team 

For better or worse, doctors aren’t the only people outside the company who are part of the claims process. Attorneys, medical case managers, and other types of vendors might be necessary at certain parts of the process. The specific vendors that need to be involved can vary from one company to the next depending on the scope and frequency of claims, among other factors. 

The key part is to remember that these also need to be trustworthy figures. Companies need to have strong relationships with outside vendors who are part of the claims process. This is why finding trustworthy doctors is so important. The same principles apply to other vendors. They need to be responsive and efficient with the work they do because employers will have to hold them accountable if they aren’t helping to make the claims process efficient. 

Never Abandon Employees 

Companies must stay involved in the claims process from start to finish. Ideally, there should be at least one person in charge of staying in touch with the employee throughout the process while also serving as a liaison between the employee and any outside vendors. Any changes or new developments need to be shared right away with as little delay as possible to help the claims process go smoothly. 

It’s also a good idea to make sure employees don’t feel like they’ve been abandoned. They need to know that the company cares about them and their recovery process. There’s no telling what an employee might do if they start to feel they are being abandoned by their employer. If nothing else, it takes away some of the structure of the claims process. Therefore, a big part of claims management is staying in touch with employees and taking care of them as much as possible. 

Create a Return to Work Program 

As mentioned, the entire process should be standardized as much as possible, including how employees ultimately return to work. This may not feel like it’s at the heart of the claims process, but it should be continued as a key part of it. After all, workplace injuries usually aren’t fully resolved until the employee who got hurt can return to work. Also, the claims process can sometimes drag on even after the employee returns to work, so getting someone back to work the right way shouldn’t be ignored. 

The bottom line is that there needs to be a plan in place for how employees will eventually return to work. This means policies and guidelines specific to the organization that will determine when returning to work is appropriate. The details can be worked out by each specific company, but there does need to be a system or program in place to make it happen. Obviously, employees shouldn’t be rushed back before they’re ready. But the sooner an employee can return to work after an injury, the better it is for the claims process. This is why helping someone return to work should be considered part of the process. 

Learn Lessons 

No company is going to be perfect when it comes to claims management. Even with a good structure and plan in place, there are bound to be bumps in the road. That’s just the nature of the claims process. The important thing is to keep learning and trying to perfect the process as much as possible. With every claim that’s made, data is collected that can provide insight into how that claim was managed. That data can be organized and studied, especially with help from the right software, to learn how the process can be improved. Even companies that have found a standardized way of handling claims should stay open to potential changes.  

At the same time, it’s important to learn lessons regarding how workplace injuries happen in the first place. A proper safety management system can help to organize all workplace safety activities and improve how a company approaches employee health and safety. This can lead to a reduction in accidents and injuries, which will also reduce the number of injury claims being made by employees. In the long run, this will be what’s best for both employees and the company.