Dateline: NH, June 2018
Why the Call?
Marta Silakka RN, BSN, Nurse Case Manager
Most members have had the pleasure of a visit from Bernie Hecht, our vocational rehabilitation specialist; he comes by for new member training and attends safety committee meetings along with our Loss Prevention team. Bernie will educate new members and re-educate existing members on what to do when an employee gets injured on the job. One instruction he will always give is: “Don’t forget to call the nurse.” This suggestion pertains specifically to the call into the NHADA’s Workers’ Compensation Trust (WCT) office at the time of an injury. The purpose of the call is to alert us to the injury and allow us to assist with a network referral for medical treatment; but the call is actually so much more than that.
Placing the call to us as soon as possible after the injury, gets us in the loop.
• It allows us to help with the referral for medical care within the managed care network if treatment is needed. We then are able to prevent out-of-network treatment.
• It leads to a better outcome as we become involved at the earliest possible point and can assist with all aspects of the claim prior to receiving the Employers First Report of Injury.
Almost on a daily basis we receive calls from folks just wanting “to bounce this off you guys” or because “we aren’t sure what to do” or because “I have a bad one I think”.
We are here to help. If the questions pertain to workers’ compensation and NH law, we have you covered. We have combined, in-house experience in the industry, based on the longevity of our in-house staff, ranging from 10 to 35 years with NHADA, most of us having worked in the insurance industry our entire careers. We stay on top of what is new in the workers’ compensation system and the industry by taking part in regular continuing education and advancement training for our licensing. At the same time, we know when we can’t help, but we will never leave you floundering. We have “legal hotlines” set up for our members so, if you call and we don’t have the answer, we will give you the legal hotline information.
Just as when you present to an Emergency Room or urgent care center for medical treatment, when you are being asked about details of the injury or illness, your call to us does very similar things, though for different reasons. When you call us about an injury before medical care has been sought, we will assist with the referral to the most appropriate medical specialty. It can be assumed that the Emergency Room or an Urgent Care is the best first step, but the call to us can lead to a review of the details of the injury, and we may then determine the best route of care, which may be to start with an eye doctor, an orthopedic doctor, or the occupational medicine provider.
It’s All in the Details
When you call us, please don’t hold back any details. If the injured worker needs medical care, we will promptly help you out with that.
The call won’t take long. We’ll need a brief overview of what happened. We will ask the date and time of the injury, what body part is injured, how the incident occurred, and if any medical care has been provided yet or first aid on site. The more information the better; as an example, the injured worker has a laceration on his left hand; we will ask how the laceration occurred. You may respond, “with a razor knife.” But we will want to know what he was doing when he cut himself. The more information we have initially, the better we are able to assist with not only the initial medical treatment but also the entire management of the claim.
We may ask for additional information during this call, depending on the mechanism or extent of the injury. The adjusters may want to know if there were witnesses to the incident, if there may be surveillance video of the area where the employee was injured, if a defective tool caused the injury, and if safety precautions were adhered to. All details are important to us and to the management of the claim.
Early Return to Temporary Alternative Duty
Once the call has been placed to us, we have assisted with the referral for medical care, but we are not done at that point. We are just getting started!
The medical providers will fax or email us a copy of the NH Workers’ Comp Medical Form after the injured worker’s appointment. This form, as you know, outlines the medical management of the injury as well as the employee’s work status. Once we get the form, we are able to assist with the employee’s return to work, whether that may be full-duty, light-duty, or even if there is time suggested to be out of work.
When our involvement starts early — with that call at the time of the injury — we are able to manage the claim even before we get your, Employers First Report of Injury. Quite often, an injured worker may have a light-duty release but not return to work because they think “there is no light duty for me”. By getting the call to help with the referral, followed by the outlined work status on the WC form, we are able to assist early on with getting the injured worker back to work, per the restrictions. If the form provides a light-duty release, we can promptly follow up with you to help identify light duty jobs and keep the injured worker working.
Bernie Hecht is NHADA’s expert at assisting with identifying light-duty jobs. If the form shows more restrictions than you think you can accommodate, call Bernie! We will be there to assist in keeping the case from becoming a lost-time claim, which is what will happen if you cannot accommodate the light duty.
Documentation and Time Lines
The call to us starts the file for the injured worker. We fill out an intake form at the time of the call, documenting all the details and the referral for medical care. When we receive the NH Workers’ Comp Medical Form, we add that to the file, all before we have the Employers First Report of Injury. Depending on the need identified, the file may be passed to different members of the WCT claims team. From filling in the details of the injury to medical care and getting the injured worker back to light duty, the entire team may be touching the file. Each of us has a specific role and expertise in managing the claim.
Many aspects of the claim have time lines to follow. Deadlines for filing claims and specific forms must be filled out. Our website at www.nhada.com has most of the forms. We welcome your calls and will assist you in the timely filing of the claim and completion of required documentation.
Please call us first whenever you have an injury in your workplace, and together we will work to ensure the injured employee gets the best medical attention available and returns to work quickly and safely. Reach us for help at 800-852-3371.