Injured worker getting help from a doctor

Keeping Your Costs Down in a Retro Environment Thru Claims Management

Most people know that in Washington, a Retro program is a safety incentive program that allows employers to earn refunds on their Labor & Industries (L&I) workers’ compensation insurance premiums. The goal for most employers is the refund, but how can you get a refund and keep your costs from escalating when you have a workers’ compensation claim?

There are so many steps from the beginning of a claim to the end, and it can be quite overwhelming at times. Proactive claims management in a Retro environment is how we can help the employer bring claims from opening to closing and hopefully help keep costs minimal. Light-duty, formal job offers, and Kept on Salary (KOS) are the three most significant ways to keep costs down. It is a team effort between the employer and their claims management team, and communication is key.

You Get a Claim – What Do You Do?

Let your claim management team know as soon as possible. We are here for you, and the sooner we know about a claim, the more time we have to get on top of any potential issue and adjudicate it appropriately. If you question the validity, something seems off, or you just can’t see how an injury happened – have that conversation with your claim management team. Let the team know your concerns, frustrations, or questions. Let them know the why so they can navigate through the claim and have needed conversations with L&I.

Light-Duty & Formal Job Offers

Your employee has gone to the doctor due to his injury and is given restrictions – what do you do?

At this time, you are looking for light-duty that falls within the restrictions provided by the attending physician. What jobs, duties, or procedures can you have the injured worker perform that falls within the restrictions given by the attending physician? Once you have established any potential light-duty jobs, you will want to complete a light-duty job description and have it reviewed by the injured worker’s attending physician for approval.

It is also important for the attending physician to be aware of the light-duty job description, so they know what work you’re asking the injured worker to perform. Even if an attending physician says an injured worker cannot return to work at all right now, it is always good to be proactive at getting a light-duty job description in front of the attending physician. A lot of times, an injured worker will tell their attending physician that their company doesn’t have light-duty available. Sending over a light-duty job description lets the attending physician know that you do have light-duty work and are trying to accommodate the restrictions given. Many times, seeing a light-duty job description will change an attending physician’s mind and get the injured worker back to work sooner.

Once the light-duty job description has been approved and sent back, it is highly recommended that a formal job offer be completed for the injured worker to sign. Why? Getting an injured worker back to work is one of the biggest cost savers in a Retro environment. It can prevent time-loss from starting or stop it if it has begun as long as all steps are met. In addition to the potential for more Retro rebates, reducing time-loss also helps keep future insurance rates low. And if that wasn’t incentive enough, as a bonus, if you provide light-duty to your injured worker, you can also request a Washington Stay-at-Work (SAW) reimbursement. SAW is a program L&I offers to employers as an incentive to bring injured workers back to work. This program offers employers 50% of the worker’s base wages up to $10,000 or 66 days worked in the light-duty job – whichever comes first, as well as reimbursement for some of the training, tools, or clothing needed to do the light-duty job. SAW reimbursements are only available if a formal job offer has been made.

Why should a formal job offer be completed?

If you have a signed, light-duty job description and complete a formal job offer to the injured worker and the worker decides they don’t want to do the light-duty job, quits, resigns, or is fired for cause, then the worker is not eligible for time-loss benefits. If there is no signed light-duty description and no formal job offer letter and the injured worker decides he or she doesn’t want to do the light-duty job, quits, resigns, or is fired for cause, time-loss will be paid which in turn increases the costs of the claim. The formal job offer is the best way to protect the employer during this time.

Kept on Salary (KOS)

Another way to help keep your costs down in a retro environment is to consider Kept on Salary, also known as KOS. If the attending physician does take an injured worker completely off work, you have the opportunity to provide KOS. This means you would pay the injured worker’s salary as if they were never injured. You also do not use sick, vacation, or PTO to cover any of the time the injured worker is off from work. By providing KOS, the claim is kept as a medical-only claim instead of a time-loss claim. Why is this important? It is important because reserves are established on all claims for all situations. If a claim is classified as a medical-only claim, it will be reserved with no time-loss reserves. If an employer does not provide KOS or bring an injured worker back to work, then time-loss reserves are added to consider the life of the claim, including future medical payments, Permanent Partial Disability (PPD), and time-loss payments. The life of the claim can be anywhere from a few months to a few years, depending on the injury severity and treatment plan.

Light-duty, formal job offers, and KOS are the three most significant ways to keep costs down. If you cannot provide any of these services for your injured worker, open communication with your claims management team is vital. Open communication between the employer and the claims management team helps everyone stay on the same page, understand all the details of the claim, and explain how and why the claim is moving as it is. Remember, a claims management team has the experience and expertise to move claims forward, including:

  • Helping employers come up with creative light-duty job descriptions
  • Reviewing the medical files in the claim to make sure there are no red flags and the treatment appears to be appropriate for the injury sustained
  • Looking for and addressing any issues that may come up during the claim
  • Verifying all Orders issued by L&I to make sure they are correct and appropriate for the injury sustained
  • Reviewing reserves to verify they are accurate for the injury sustained and having conversations with the claim managers at L&I to ensure the goal of claim closure can be achieved

Claims do not always go the way we want them to, however having open communication and listening to what is being said on both sides can help navigate any claim situation.

Claims management services at Archbright are unique. We emphasize accident prevention, light-duty return-to-work, with Stay-at-Work reimbursement from L&I. Our Retro program returns all Retro rebates to the group and distributes them to members based on merit, so members consistently earn the refunds they deserve year after year.

To learn more about Retro and Archbright’s program, view our 2-minute video. And for a deeper dive into our Manufacturing Retro program, download our whitepaper today.

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Trish Guadagnoli

Trish Guadagnoli, Sr. Claims Examiner, has been with Archbright since 2019. She has been working in Workers' Compensation in multiple states and jurisdictions since 1992, and in Retro since 2010.