Medical Claims: Stopping the “Snowball Effect” with Early Intervention

When an employee is injured, an employer might take a hands-off approach to their care without realizing that it can present additional risks—both for the employee and employer.

A “wait and see” approach for medical claims is especially tempting for what starts out as a seemingly benign condition. For example, the head injury that’s being treated only for its side effects (like migraines or light sensitivity) but then snowballs into a more significant medical issue (like post-concussive syndrome) because the overall condition wasn’t benchmarked or monitored early.

So, over time, what looks like it will cost the least can actually cost employees and employers the most. Risk managers already know this and have tried to be proactive before, but—when you’re not a medical expert—how do you get your company to listen?

To stop minor medical claims from becoming major ones, early intervention is crucial.

Investing in early intervention benefits both your injured workers and your organization—here’s how:

Benefits for Employees

• Faster recovery
• Reduced injury severity and likelihood of chronic issues
• Reduced medical and disability costs
• More efficient case management and care coordination
• Improved claimant experience through additional support

Benefits for Employers

• Lower claim costs
• Shorter claim duration and quicker Return to Work
• Lower workers’ comp insurance premiums
• Reduced likelihood of legal disputes

How Our Early Intervention Team Supports Risk Managers & Their Employees

Our team helps risk managers and injured workers understand the potential outcome of medical claims based on a comprehensive set of factors. These can include medical history, current medical conditions, prescriptions, patient compliance with treatment, and more.

We know you and your injured team members can’t afford to “wait and see” for certain types of medical claims. So when a client calls us, our RapidResponse nurse triage team gets back to them in less than 24 hours with medical recommendations and a case manager.

Here are a few of the most common types of injuries and conditions where we see early intervention can have a real impact:

• Catastrophic Care. Each year, 11 million adults face catastrophic health issues in the U.S. alone. To help support them and their employers, our team handles cases for multiple traumas, complex fractures, third degree and chemical burns, spinal cord injuries, major head injuries, amputations, paralysis, stroke, septicemia, chemical inhalation, myocardial infarction, severe puncture wounds and more.
• Minor Head Injuries. Each year, 8 million new brain injuries occur in the U.S. Our team works with the employees who have non-traumatic brain injuries (such as concussions or contusions) to stop these minor issues from becoming major.
• Pain Management & Addictions. Pain medicines are a major factor in overdose deaths, with opioids being particularly troublesome—in 2023, they were involved in nearly 76% of fatalities. Our team helps with individualized treatment approaches, monitors for warning flags such as excess medication utilization, and more.
• Exposure. Some employees frequently come in contact with high-risk populations or work in communal environments where they’re more likely to be exposed to airborne or bacterial infections (such as Methicillin-Resistant Staphylococcus Aureus (MRSA) or tuberculosis). Our team provides education and direction to care that is in compliance with state and CDC regulations. Follow-up monitoring will also occur to ensure all exposure testing and treatment stay on track.

If you’re a risk manager who handles medical claims, we’d love to talk about how our Early Intervention Team can support your team—feel free to get in touch with me!