Hcr_230_Claims_Process

Claim Process p. I Workers' Compensation Claim Process Renee Allen University of Phoenix-Axia April 10, 2011 Sharlene Batts Claims Process p. II Workers' Compensation Claim Process The employer having knowledge of the employees work related illness or injury in a timely manner, is the first step. If this is not done within the allotted time frame then the rest of the steps will be void. The time frames are important in most of the steps taken when filling a claim. The employee will then fill out a section of the Report of Injury or Occupational Injury Form, that is required to be filled out. The supervisor then fills out their required section of the Report Injury or Occupational Injury Form. The supervisor then electronically or mailed to the carrier, the completed form to Workers' Compensation, and this must be done within two days of the injury. If by some chance the injury to the employee prevents them from reporting the accident, then the supervisor must fill out what is known, within five days, to avoid a penalty for filling too late. As soon as the employee is able to fill out the form they must do so. A coordinator for Workers' Compensation prepares an 8WC form and they submit the form to the insurance carrier and to the NH Department of Labor. From this point in time, the insurance carrier then has twenty one days to determine whether or not they are denying the claim or accepting it. During this time the coordinator will be keeping in contact with the supervisor about the status of the employee, and will be in communication with the insurance carrier with any concerns they may have. If the claim is denied, then the claim can be appealed through the NH Department of Labor. If the claim is accepted then the appropriate loss of wages and medical bills are paid for. The responsibility of the physician is to treat the patient's condition, and making the determination of the percentage of disability and what the patient;s return-to-work date is. They also have the responsibility of keeping a progress report on the substantial changes in the patient's condition. The providers charge workers' compensation's insurance carrier and the carrier sends payment to the provider directly. ( Axia ) The responsibility of the employer is filing the forms in a timely manner, all the information Claims Process p. III required. The responsibility of the insurance carrier is to assign a claim number, make a determination if it is a workers' compensation case,and to notify the employer of the determination. The carrier is also responsible for paying the employee directly, if they are eligible. ( Axia ) HIPAA rules are slightly different when dealing with Workers' Compensation claims. In some cases a health care provider can disclose information about a patient's health, to their employer, without that patient's permission. The confidentiality rules that usually apply with medical records, do not necessarily apply in some Workers' Compensation cases. Claim adjusters and employers have unrestricted access to workers' compensation files. Judicial proceedings such as subpoena's or court orders are also allowed access to the files. A person cannot restrict their information, if they are filing a claim, they need to be compliant, and a physician is only to release information pertaining to the claim, and is illegal for them to disclose information about any previous medical conditions that may have existed. ( Axia ) There a numerous implications of unrestricted access to a patient's medical record. There is the most obvious, that a patient's information could be stolen. There is always the chance that someone requests information about you that is not authorized to have it, and a mistake is made and the information is given to them. Privacy Rights Clearinghouse states, “ Your medical information is shared by a wide range of people both in and out of the health care industry. Generally, access to your records is obtained when you agree to let others see them. In reality, you may have no choice but to agree to the sharing of your health information if you want to obtain care and qualify for insurance.” (2011). Reading on into this article I read something that sorta startled me, it was not something I had thought of when it comes to the security of my information. It says, “ Find out if your health care provider has a policy on the use of cordless and cellular phones and fax machines when discussing and transmitting medical information. Wireless telephones are not as private as standard "wireline" Claims Process p. IV telephones. Because they transmit by radio wave, phone conversations can be overheard on various electronic devices. Digital systems are more secure.” ( Privacy Rights Clearinghouse. 2011). I, personally, am not comfortable with not having total control over my personal information. I do not feel that the privacy laws totally protect me. I am uncomfortable with the fact that my life can be an open book at the request of an agency or organization that is deemed “ authorized “ on the standards. Who they consider authorized may not be someone I would consider authorized. Not having the say so is what really gets to me. Claims Process p. V References Privacy Rights Clearinghouse. 2011. retrieved from http://www.privacyrights.org/fs/fs8-med.htm#C Valerius, J., Bayes, N, C., & Seggern, J. (2008). Medical Insurance