Claims Management: One Call Away

Sometimes workplace injuries happen—and employers who participate in MBAKS’ GRIP program have ERNwest there to help, by providing the resources and expertise needed. But what happens when an injury is unrelated to the workplace, or even worse, fraudulent?

Workers’ compensation fraud is incredibly costly. In a 2019 study, “the L&I’s Detection and Tracking Unit (DTU) evaluated more than 8,100 individual workers’ compensation claims. These evaluations led to over 420 investigations; of those investigations, 47 found that fraud (willful misrepresentation) occurred. As a result, L&I collected nearly $1.35 million in overpayments and penalties.” These impacts can have catastrophic effects on businesses of any size.

“If it’s difficult for an individual to dispute a traffic ticket, imagine how hard it is for a business to dispute a fraudulent worker’s comp claim without witnesses, testimony, or a legal team.”

A claim is filed when an injured worker goes to the doctor, and the provider sends claim form to Labor and Industries (L&I). For GRIP members, the next step is to notify the ERNwest team about any workplace injuries so their claims team can guide them through the claim process.

This is vital as most businesses don’t have an extensive administrative team to manage complex workers’ compensation claims. This process can be costly and confusing for those not well versed in workers’ compensation laws, meaning that businesses without an administrator like ERNwest will be left to navigate a complex process alone.

Additionally, because the burden of proof is left on the employer to dispute the origin of the injury, it’s hard to know what questions to ask and how to be an advocate for your business. If it’s difficult for an individual to dispute a traffic ticket, imagine how hard it is for a business to dispute a fraudulent worker’s comp claim without witnesses, testimony, or a legal team.

While an overwhelming majority of claims are legitimate GRIP members can feel confident that the claims process has a series of checks, balances, and strategies—like modified duty work—in place to mitigate claim costs.

So, if an injury does happen, you won’t have to scramble for answers or guidance—You know help is only one phone call away. If something was going to cost your business thousands of dollars, wouldn’t you want an expert on the job?

Learn more about the benefits of membership at mbagrip.com.