As members of the Worker’s Comp Trust, you are aware of our recent change to The Windham Group for managed care. We are excited about this change and a new partnership. The best news of all is the preferred providers we have grown to trust are still in the network, and they will be there to care for our injured workers and to take care of all our occupational health needs. NHADA-WCT prides itself on the relationships we have built with these amazing providers and are glad to know they are still there for our members. Being able to access the same day care with specialists is a priceless benefit, and we are happy that will continue.
Change is great when there are no speed bumps to pass over. It’s also a great time to review some of the processes we have in place that ensure prompt in-network care with the most appropriate specialist.
The key to successful management of a work injury is communication. The earlier the communication starts after an injury has occurred, the better, which is why we say, “Yes, you still need to call the nurse.” Here are some reasons why that call is so important:
- Always remember, in the case of a life-threatening emergency, call 911 first and follow up with us after so we
- Calling in right after an injury occurs starts the communication and the documentation of the injury. Essentially you have the WCT team at work on the claim before you have even filed the claim officially with us.
- Calling in starts a dialogue between the employer, the injured worker and us. This call allows us all to gather information regarding the injury and the best next step.
- During this call, the details of the injury are gathered and the most appropriate in-network referral can be made. We are able to refer to occupational health clinics and specialty services on the same day. Not only is the network an important piece, but the level of specialty is as well.
- We can also briefly review with the injured worker how to share our information with the provider and what to do if they get a prescription. This call can assist us in making sure the bills for themedical treatment come to us promptly and avoid the injured worker mistakenly receiving any billing.
- After the decision regarding medical care and treatment is addressed during the call, we are then able to cover other important details. We will document the description of the injury and note the date and time of the incident. We may ask you questions regarding witnesses and also about video footage of the incident.
- If there were any safety concerns that arise around the injury, this call allows us to alert our Loss Prevention team and arrange for them to visit and assist.
- This call is a perfect time to also review with the employer filing the First Report of Injury. At times during this call, we find there has been turnover and training is needed regarding the filing process. We can arrange to have Deb Handrahan visit and train new managers and or human resources staff on the WC process.
- Reviewing what happens after treatment can also be covered in this call. You can discuss what paperwork will be given to the injured worker after the appointment and the need to share with the employer. We can also briefly touch on light duty and what that means to the employer and the injured worker.
This sounds like an awful lot to cover in a short “call to the nurse,” but we assure you the call is not long, and the information gathered during it is invaluable to the management of the claim. As mentioned, it allows us to start managing the claim before the official paperwork has been filed. The documentation from the call is held, and if we haven’t received your First Report of Injury in the requested time frame, it allows us to follow up with the member regarding filing.
The entire WCT Claims Team is able to take these calls in the event the nurse is on the other line assisting another member. A call into NHADA WCT regarding an injury will never go to voicemail. When calling in, always share you are calling in an injury, and you will be put through to a member of the team. During the pandemic, we may need to take your name & number and have a member of the team call you back. If this occurs, you will receive a call back within five minutes.
As always, please reach out with questions regarding the WCT process, or if you have any questions about our new managed care provider, we are here to assist! To contact the team, you can call our main number 800-852-3372 or email any of us.
Pete Sheffer, claims manager — email@example.com
Marta Silakka, nurse case manager — firstname.lastname@example.org
Deb Handrahan, member services coordinator — email@example.com
Justin Dowdy, claims adjuster — firstname.lastname@example.org