Claims Coordination and Oversight Services
Are your locations burdened with triaging injured workers, directing care and coordinating all aspects of the Workers’ Compensation process?
Alta is providing a “Claims Concierge” product to large public entities. This encompasses 24/7/365 Nurse Case Triage partnered with an Alta-provided Workers’ Compensation Coordinator.
Clinical Triage
24/7/365 Access to a Nurse
Our Clients are provided with a dedicated toll-free number for anyone injured on the job, at any time of the day, any day of the week to contact and secure clinical advice and direction.
Clinical Triage
The Alta provided Nurse will triage the injured employee by asking a series of questions. Through this triage it will be determined if the employee should treat the injury with at home first aid care or be directed to a clinic.
Spanish speaking Nurses are available. When different languages are required, translators are available.
No employee will be denied access to a clinic if this is their desire.
If it is determined that the employee only requires first aid care, they have access to contact the Triage Nurse in the future, if they feel this need has changed.
Directing Medical Care
If the triage interview determines the employee requires care at a clinical setting, the Nurse will contact the designated clinic and authorize care, creating a seamless experience for the injured worker.
Completing Incident Reports
The Triage Nurse will gather all the necessary information for the claim to be reported to the Third-Party Administrator, taking this burden off the frontline manager.
Workers’ Compensation Coordination
Alta’s Workers’ Compensation Coordinator
Once the Triage Nurse has completed the interview and gathered all the necessary information it will be handed off to Alta’s Workers’ Compensation Coordinator for the matter to be reported to the Third-Party Administrator.
To avoid California DWC-1 Claim Forms being provided on incident only claims, it is recommended the Workers’ Compensation Claims Coordinator be the one to decide if it is owed and provide it.
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Alta’s Workers’ Compensation Coordinator will reach out to the medical clinic to determine the next appointment, work restrictions and if the clinic needs anything to proceed forward with treatment.
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Alta’s Workers’ Compensation Coordinator will reach out to the Client’s Frontline Manager, ensure they are aware of the injury occurred and discuss any concerns they have as well as any need for temporary accommodation.
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The final contact will be with the Employee to discuss the injury, parts of the body injured, and medical care received. The WCC will provide education on the claim process and what the injured worker should expect. If the Employee is losing time from work, the WCC will have a discussion regarding potential entitlement to Salary Continuation, 4850 Benefits or Industrial Disability Leave.
This discussion is held to build rapport and trust that the dedicated WCC can act as the Employee’s trusted advisor regarding any questions or concerns the Employee will have about how the claim is being handled by Third Party Claim Administrator.
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Alta’s WCC will report the claim to the Third-Party Claim Administrator as soon as it is possible, meeting any required best practices.
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Upon an injury occurring Alta’s Workers’ Compensation Coordinator will reach out to applicable stakeholders.
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If the Employee is losing time from work, the WCC will coordinate with Payroll concerning any entitlement to salary continuation/4850 benefits. This coordination with Payroll is ongoing for the length the employee is off work because of the injury.
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The Alta WCC will notify all designees potentially including EH&S, concerning the mechanism of injury to assist with loss prevention efforts.
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Alta’s WCC will reach out to the assigned Claim Examiner to discuss the case and secure the Examiner’s plan of action. This contact is ongoing concerning all aspects of the case.
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The WCC will work directly with the Frontline Manager and Medical Provider concerning the need for and accommodation of temporary work restrictions. The WCC will also inform designated stakeholders of permanent accommodation to facilitate the interactive discussion.
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At a cadence decided by the Client, the WCC will hold a call to review the status of all open claims as well as any new claims reported. Alta currently provides this to current Clients completing a spreadsheet noting elements, such as, lost time from work, accommodation, restrictions, permanent work restrictions, the need for an interactive discussion and if it took place. This is not an exhaustive list of the elements being tracked and provided.
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The Alta WCC work as our Client’s on demand workers’ compensation subject matter expert.
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The Alta WCC will coordinate all aspects of the workers’ compensation claim with the Location, Medical Provider, third party administrator and all designated stakeholders concerning each individual claim, needs, impediments and action plans.
Contact Us to Learn More
Contact Us to Learn More