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Internet Technology Improves Workers' Compensation Results 
By Randy Wheeler
For public entities, the main goal of workers' compensation has always been to respond to
workplace injuries with the most appropriate medical care at a reasonable cost, and to return
employees back to work as soon as medically possible.
In the last three years, however, workers' compensation costs have risen dramatically, driven in
part by significant increases in medical costs and indemnity expenses.
Public entities share the same objectives regarding workers' compensation: reduce injuries,
medical costs, indemnity costs and litigation; increase the efficiency of the claims process; and
improve quality of care for injured workers. To achieve these business objectives, many public
risk managers and claims professionals are now leveraging the Internet for its cost and
efficiency benefits to streamline workers' compensation best practices.
Claims Management Challenges
For many organizations, claims processing has changed little over the years-often involving
manual data entry, inconsistent claims review, inefficient workflow, fragmented communication
and frequent mistakes. Thus, claims handlers may spend half their day on routine administrative
tasks.
The main challenge of claims management is automating and streamlining routine
administrative tasks and labor-intensive manual functions, focusing specialized resources where
they are needed most. Experienced adjusters and claims managers believe technology is an
enabler of these objectives.
Risk Management Needs
From a risk management perspective, the biggest problem in workers' compensation is not
knowing where losses are coming from and not being able to pinpoint areas that would benefit
from loss-control programs. Under pressure to control costs, risk managers are demanding a
higher level of customization in their risk management reports and performing ad hoc reporting
that enables analysis from different angles. With today's technology, these risk management
reports combined with an increased focus on benchmarking initiatives will enable organizations
to implement timely interventions that reduce costs and improve outcomes.
Solution: Advantage of Internet Technology
The Internet represents the most dramatic change in the modern claims operation. Public risk
managers are beginning to implement Internet tools in their programs, providing connectivity,
transparency, and real-time benefits.
Connectivity is the main advantage of the Internet, allowing individuals to share information as it
develops and to access it at anytime, from anywhere. This is a convenient, cost-effective
solution for public entities, which frequently have team members distributed across large
regions.
Internet technology also allows busy claims and risk managers to retrieve information from one
location, without having to access multiple applications or Web sites. The transfer and
management of this information remain transparent to the user, which is a key benefit as the
claims process becomes increasingly automated and paperless.
An added impact of the Internet is its ability to provide real-time business intelligence, enabling
stakeholders to manage claims for optimal costs and outcomes.
The following items are internet technology benefits that support business objectives and best
practices:
- An electronic claims process - It is the primary goal of today's Internet systems to achieve
an end-to-end automated and electronic claims administration process. Scanning and document
imaging can increase the volume of claims handled and properly document claims activity
without increasing overhead.
- Web sites that enable prompt electronic reporting - If injuries are promptly reported, public
entities can better focus on early and appropriate interventions. Frontline managers can easily
report incidents on a secure Web site, where the report is saved directly into the claims system.
- Integrated EDI to meet state-mandated electronic claims filing and reporting - Many
states have some form of electronic claims filing and reporting requirement. Internet technology
provides the instant and electronic connectivity to comply with these mandates.
- Verifying claims information to reduce errors - The connectivity and transparency of
Internet technology allows real-time validation of information to occur seamlessly.
- Avoid statutory penalties with business rules - If organizations do not meet workers'
compensation statutory timelines, they face stiff penalties. Internet-based business rules
automatically track these timelines and notify adjusters and risk managers when specific actions
must be taken.
- Business rules notify appropriate resources of urgent activity - Business rules
automatically notify the appropriate resource to review the claim and automatically assign the
case to the appropriate adjuster, who then performs the initial three-points of contact. External
parties, such as return-to-work coordinators and nurse case managers are also notified to begin
their part of the claims process. Notifications can be made via email, pager, and mobile phone
for added convenience.
- Claims email integrates communication and documentation - If adjusters send email, it
should automatically be documented within the claim file, along with any replies or related
documents. Integrated claims email allows email to be sent within the claims system, so that
external applications are unnecessary.
- Managing return-to-work programs - One of the biggest factors that can impact claims costs
is the establishment of a formalized return-to-work (RTW) program. Modified duty assignments
can be sent in a timely manner between claims adjusters, nurse case managers and providers
using Internet-based tools.
- Enterprise risk management reports - loss control and injury prevention - Internet-based
technology effectively captures the full range of workers' compensation claims data, enabling
risk managers to view loss runs online with a high degree of customization. By using these
reports to identify a program's true cost drivers, appropriate loss control programs can be
designed for high-risk areas.
The Future of Internet Technology
With the use of Internet technology, adjusters' and claims managers' tasks can be automated so
their resources can focus on the client and the claim, not the back office. Risk managers can
carefully monitor loss control programs and implement solutions to reduce costs. As the use of
technology is more prevalent, more best practices will be revealed and implemented with the
same goal-to get the employee back to work as soon as medically possible.
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Kevin Confetti