Investigation
Our most challenging area of opportunities for the month of May.
Medical Injury screen
Were medical payments evaluated and paid accurately and timely, and was the accepted medical treatment related to the compensable injury. Name the error.
Surveillance was paid out of medical but should have been paid out of expense.
After initial contact on 10/27 , no further contact noted with insured. Name the quality question impacted.
Does the file reflect a strategic and collaborative plan with all applicable parties to transition the Injured Employee back to work.
Has eaten snake.
Kevin, Stuti and Adam
IE went to retrieve device, as he turned corner, a pallet caught his shin area on left side. IE reports a small cut about 3 inches. Name the cause of injury.
Cut, puncture, scrape, NOC
Actual wages received 06/20/2022, audit completed 03/14/2024. Name the behavior.
- Timely review of information ( address any over/underpayment)
- Audits to be completed promptly when wage info is received
After initial contact on 10/27 , no further contact noted with insured. Name the quality question impacted.
Was there proactive communication with the applicable parties to ensure understanding of the claim status and process as warranted?
Has eaten turtle.
Sharissa and Adam
The IE was diagnosed with de Quervain's. Name the part of body.
Wrist
Has eaten goat head soup.
Shaunita and Adam
IE picked up a box of peanuts and hurt her back. Name the cause of injury.
Lifting
Has eaten a kangaroo.
Annette and Adam
Contact note indicate current role is repetitive with use of tweezers and small instruments. Claim accepted. Name the opportunity.
- meaningful contact
- obtaining JD/ questions around job duties
- length of time in position or time each day doing rep work
- hobbies etc.
GA - DOL 06/01/2022, LD 09/06/2023,Voluntary Resignation, 09/6/2023, Settlement 04/03/2024. No FD release. Name the correct RTW screens.
Disability Start Date 06/02/2022
Light duty release and choose no RTW 09/06/2023
Benefits Exhausted 04/03/2024
Has Eaten frog legs.
Kristy and Adam