The majority of claims are not complex. Sure there may be some hiccups along the way, but claims are usually administered, workers get timely and proper treatment, and claims will close.
Unfortunately, it is not the typical claim that costs the employer the most. It is the atypical, expensive, drawn out claim with the unusual medical condition or the condition that evolves to include multiple body parts without any logical explanation that costs the employer.
How does an employer avoid those complex claims and control costs?
Of course there's no magical crystal ball, and there's no box for the claimant to check to let you know that their claim is going to turn into a years-long adversarial relationship between the employer and worker. However, an employer can get a sense of the beginnings of a complex claim by paying attention to some warning signs.
For instance, were there disciplinary issues immediately prior to filing of the claim? For instance, is the date of injury within a matter of days of a disciplinary action? Or perhaps the worker's spouse has a medical condition that requires care, and the only available caregiver is the worker? Or how about the case of a "normal" condition that suddenly evolves to involve multiple body parts?
Another factor that may make the claim complex is the nervous claimant. Let's face it, the worker's comp system in Washington involves a lot of laws, rules, and policies that are sometimes in conflict with each other. Your claimant may not understand how the system works, and may be confused, distrustful, or just scared of what may happen in the future.
What about the worker's attorney? Is the worker's attorney facilitating administration or putting barriers in the way to delay administration? Does the attorney have a reputation for making claims worse, taking every case to litigation, or engaging in other questionable conduct?
While a single one of these "red flags" may not be indicative of a complex claim, they do provide some warning to the employer to proceed with caution.
So what do you, as the employer do? Follow my blog as I discuss both general and specific strategies for handling the complex claim. Of course, I am happy to answer any questions you may have, so please contact me and I will be happy to discuss your specific case with you!