Tips for Teamwork
The Office of Workers’ Compensation is pleased to present a series of email snippets of helpful information about the claims process titled Tips for Teamwork. These Tips are emailed to all Workers’ Compensation Coordinators and will be archived on the website by title. If there is something that you’ve been wondering about, the chances are someone else has the same or a similar question that can be explained in a future Tip. Email your question to firstname.lastname@example.org.
Many of you have probably noticed that the Supplementary Report can no longer be found on the Virginia Workers’ Compensation Commission website. That’s because it is no longer a required or recognized form of the VWCC. What this means for your agency is that MCI no longer requires the utilization of this form either! While the form is not required, the communication of various changes in work status, which results in lost time or return-to-work, is still vitally important to the management of your employee’s workers’ compensation claim. Immediate notification of the following is the key to ensuring accurate payments to your agency and the injured worker:
* An injured worker’s lost time from work
* An injured worker’s return to work at either full duty or modified duty
* A change in an injured worker’s earnings
* A change in an injured worker’s employment status
* A change in the number of hours an injured worker works
You are also welcome to keep reporting lost time and return to work via the Supplementary Report. The choice is all yours. For those of you electing to continue using the Supplementary Report you can find the form on www.covwc.com in our Forms Library.
Wage information is required on all lost time (indemnity) claims. MCI has generally required the utilization of the Wage Chart (Form 7A) for reporting of wages. However, we recognize that agencies may have other, more convenient ways of providing wage information. If you can provide complete wage information by utilizing other means available to your agency, we can accept same in lieu of the Wage Chart. Just keep in mind that there may still be the occasional claim requiring a Wage Chart. For example, injured worker’s dispute of the average weekly wage or compensation rate, or specific request from the Attorney General’s Office or Virginia Workers’ Compensation Commission. Interested? If so, contact Kitty Hughes at email@example.com for guidance on how to make the change.
Developing a Job Description
The Claims Department relies upon Employee Work Profiles or other documentation in support of an Employee’s Job Description to communicate with medical providers regarding return-to-work capability. The documentation can also support termination of benefits, when the employment relationship has been severed, if we can demonstrate that the injured worker has the capacity to return to a comparable position based upon the physical demands of the pre-injury position. Finally, it can be an integral part of the Vocational Rehabilitation process by providing documentation of transferable skills, assisting in the search for suitable alternative employment.
Occasionally no documentation is available. For this reason we would like to draw your attention to a useful resource tool, the Dictionary of Occupational Titles (www.occupationalinfo.org), published by the U.S. Department of Labor. The tool will allow you to research positions by Occupational Title, Standard Industrial Classifications (SIC) codes, and/or Occupational Information.
Please consider reviewing and using this tool if your Benefit Coordinator asks you for information about a Job Description and none is available.
The Importance of Proper Case
When submitting claims via VLW Sedgwick Employer Accident Report Portal, the text case that you use has a downstream impact. Keep in mind that the text you enter is ingested into Sedgwick’s Claim System, just as it is entered into VLW. Entering the injured worker’s name in all uppercase text or all lowercase text impacts the quality and efficiency of letters that are produced from within the claim system. If entered in all CAPS the inside address and salutation of an MCI letter would read:
P.O. BOX 1140
Dear Ms. GOUGH
If entered in all lowercase letters:
p.o. box 1140
richmond, va 23218
Dear Ms. gough
In order to issue accurate and professional letters, the benefit coordinator would need to manually correct each communication issued from the claim system, impacting efficiency, or would need to correct the text now residing in the claim system. While correcting the text in the claim system is easy enough, each change prompts an electronic data interchange (EDI) filing with the Virginia Workers’ Compensation Commission. Each of those has an associated cost.
For these reasons, we ask that you enter data into VLW using proper case text (first-letter uppercase and the rest lowercase).
Submitting Claims Through VLW
If you are responsible for submitting claims through VLW, remember you can use the Comments to Carrier Claim Staff field to communicate important information to the assigned benefit coordinator. Any information included in this field will be acknowledged by the benefit coordinator.
We’ve probably all had a minor cut or bruise in our life. No big deal, right? We didn’t go to the doctor or require any other type of treatment, but the incident did happen.
This same thing happens to our employees at work. The truth of the matter is that sometimes these seemingly minor incidents can turn into something more severe. This is one reason why it is important to report all accidents no matter how minor they seem, to MCI. Injuries requiring no medical treatment or lost time from work are categorized as Record Only claims when reporting through VLW. Reporting the claim helps to preserve the facts and necessary information should treatment or lost time occur in the future.
Photos of an Accident Scenes or Claim Investigations
If you have photos regarding the accident scene or claim investigation please email the digital photos as attachments instead of screenshotting the photo. Additionally, avoid printing out photos and mailing them to MCI. Scanning a printed picture results in significant quality degradation.
* Be certain to identify whether the right or left body part injured when reporting a work injury. Lack of specificity can cause confusion and prolonged investigation.
* Please remember to log into Visual Report Studio to review your agency’s push reports.
Panel of Physicians
We have recently heard from several agencies who have had difficulty forming panels of physicians from the program’s PPO network. Because of this, we wanted to share some information about how the network is verified and also to pass along a reminder of a helpful service that is available to you.
The network is validated annually (the practice is still in business, still accepting workers’ compensation patients and still willing/eligible to be in the network). It is important to remember that providers close or change their willingness to accept certain kinds of patients throughout the year and because of this, we wanted to remind you that you can contact the network’s Client Services directly and they will provide you with a valid panel of physicians in your geographic area, already vetted to confirm that they are still practicing and able to accept a new workers’ compensation patient. This is the most efficient way to get help constructing a valid panel from the PPO network. The WCS Return-to-Work Unit, the Benefit Coordinators and the Medical Consultants have been helpful to many of you in the past, but only have access to the same information you have on the network. Client Services stands ready to give you the most up-to-date and reliable information available.
For more help/information see the How to Develop a Panel of Physicians Guide.
Contact Client Services in one of two ways. They are staffed Monday through Friday from 8:00 a.m. to 5:00 p.m. CST:
Call them at 800.734.4460 or email them at ClientServices@RHGNet.com.
As a helpful reminder, if you have an employee who needs urgent treatment, please send them to the nearest emergency room or urgent care center to receive the urgent care they need. Make sure that they check back in with you after the urgent care and offer them the panel of physicians at that time. There is no need to make them wait for a panel if urgent care is needed, but be sure your employee understands that they must select a panel physician for continuing care afterwards.
The ABCs to Improving Disability Approvals
Have you ever been frustrated by disability approvals or reimbursement of indemnity benefits to your agency that are issued based on inaccurate information? Have you ever spoken with a Benefit Coordinator and realized that they don’t have the information that you have? It takes real teamwork among the Agencies, Benefit Coordinators, and the VSDP Coordinator – the Disability ABCs – to ensure that information flows quickly to facilitate timely and accurate approvals on a claim.
MCI Benefit Coordinators are not only responsible for timely and accurate payment of workers’ compensation benefits, but for those employees receiving occupational VSDP benefits, they are also responsible for providing disability approval to Reed so that Reed can issue Action reports. In fact, our program’s VSDP Coordinator is dedicated to facilitating the complicated flow of information between WCS and VRS.
What can you do to help the process? Develop processes within your organization to assure that all disability slips, workers’ compensation leave slips, medical notes, internal investigative notes and the like are promptly provided to you. Then, the faster you can get the information to us, the faster and more accurate service we can provide to you, to the injured worker and to the VSDP program resulting in timely reimbursement to your agency, timely and accurate updates from MCI to Reed for Action reports, fewer telephone calls to you and less confusion for your injured workers!
Reduce Claim Reporting Lag Time
This Tip for Teamwork has to do with timely reporting of claims. Everything in the claim handling process flows from the First Report of Injury (FROI). The Governor’s Executive Order 109 (10) requires claims to be reported to WCS within 10 days. This is not only because the Virginia Workers’ Compensation Act requires us to report claims to the Commission within 10 days, but also because the earlier we can begin to work on your claims, the better job we can do in making prompt compensability decisions, getting your employees the medical treatment they need, and involving our field nurses and vocational consultants quickly to facilitate early, safe return to work. You can check your “lag time” statistics by running your “Workers’ Compensation Lag Time Report” in Visual Report Studio on demand, or check your VRS inbox for the push report delivered during the first week of each month for the previous month.