November 16, 2014
Document, Document, Document, Document Summary: In handling workers' comp claims, the first rule is, essentially, "If it ain't written down, it didn't happen." By: Daniel Holden
When I was a fledging claims examiner, I was taught the universal file mantra: res ipsa loquitor ("the thing speaks for itself"). In claim terms, it means the file should tell the story. Not a difficult concept if you think about it. I suppose a less classy version would be, ?If it ain?t written down, it didn?t happen.? But res ipsa loquitor is more than just jotting down crib notes in a file. It?s about documenting the direction in which you are headed and why. A second, equally important mantra came from a former claim manager, who said, "If you were hit by a bus, someone should be able to pick up your file and know exactly where you left off.? He went on to say that could only be achieved through clear, copious and comprehensive documentation. As a senior work comp claims consultant, I often dinged examiners for poorly documented files and a dearth of a memorialized thought processes. Occasionally, their response was akin to, ?Well, obviously youes ipsa loquitor test, which is the most critical common denominator in all the various best-practice file criteria available. An employer always has the right to know how and why a certain decision was made. Pronouncements made by insurance companies and third-party administrators (TPAs) ? which obviously affect the employer - should never be made in a vacuum. In my claim manager days, I came up with a whimsical way for my staff to visualize the documentation process. I called it HIPPO. History: What happened? Who/what/where/how? Issues: How serious was the injury? Is there timeloss involved? Plan of Action: What is the examiner?s initial plan? Is return-to-work possible? Procedure: How will the examiner begin the compensability process? Outcome: What is the examiner?s best guess at this point? Obviously, HIPPO would need to be revisited from time to time as the file matures and becomes more complicated. And, of course, the compensability aspect of the claim would be much different than a plan of action for continuing medical management. But you get the drift. And, yes, I found little plastic hippopotamuses that I placed on their desks to help them remember! For the younger generation, who seem compelled to use social media to document what they had for breakfast, perhaps this concept will come easier. Then again, documenting what you ate is a far cry from explaining why you chose that
particular food item; why it was the best choice over all others; why it made financial sense; and what gastronomical ramifications might ensue because of the choice. Bon appétit. Daniel Holden
[email protected] Dan Holden is the manager of corporate risk and insurance for Daimler Trucks North America (formerly Freightliner), a multinational truck manufacturer with total annual revenue of $15 billion. Holden has been in the insurance field for more than 30 years, beginning as a multi-line claims examiner and advancing into a number of risk management and medical cost containment positions with leading carriers and brokers.
