Delivering Better Workers’ Compensation Results for Your Customers

 Managing the Complexities of Permanent Partial Disability Claims

 Exceptional workers’ compensation coverage requires a balance of complex concerns: most importantly, the worker’s health and livelihood, but also the insured’s financial health, the quality of medical care and networks, and an injury’s monetary value. Creating a successful program requires consistent but flexible processes and knowledgeable execution.

 Consider The Hartford’s unique Permanent Partial Disability (PPD) review process. PPD is a complex issue where a worker has been injured on the job, resulting in irrevocable loss of some physical ability. In 2006, more than one-third of The Hartford’s lost time claims involved PPD. The PPD rating assigned by a doctor has a significant impact on the award to the injured worker, as well as the cost of the claim. The guidelines for assigning these ratings are complicated and can be inconsistently applied from one doctor to the next, sometimes making accurate claims settlements difficult to achieve.

 In response to this challenge, The Hartford developed an evaluation process staffed by skilled review nurses. Assisted by software that integrates American Medical Association guidelines, these nurses review and verify the accuracy of every injured worker’s PPD rating provided to The Hartford. They continually receive training on PPD developments, related medical knowledge and applicable law, and are deployed nationwide to encourage familiarity with regional laws and doctors.

 With the software and their extremely focused reviews, these nurses achieve expertise in analysis of PPD ratings that doctors, with their busy schedules, may not be able to achieve. The results of the process are more accurate outcomes and millions of dollars in PPD corrections every year.

The Review Process

When a review produces a rating different from the doctor’s, the nurse provides an explanation and recommendation. The doctor is not obligated to change the rating but often does. The Hartford has developed credibility with many doctors by following this same procedure whether the corrected rating raises or lowers the PPD rating.

If there is disagreement with a doctor over a rating and it cannot be resolved, the review nurse can provide clinical guidance to the claims handler. The claims handler may:

·              Negotiate a settlement agreement despite the rating disagreement

·              Obtain an independent medical exam

·              Litigate if she believes the doctor’s rating is significantly inaccurate

PPD is a proactive way of reaching consensus between the insurer and doctor in what might otherwise be an adversarial relationship. In fact, many doctors have welcomed this process as it helps educate them on the complex rating system. The PPD review process helps ensure consistent, accurate outcomes on every workers’ compensation claim.

To learn more about The Hartford’s workers’ compensation coverage, talk to your local sales representative.