Employer Toolbox

1. Claim Timeline:
   Elite Claims assist managers to assess the following process.
   • Claim Acceptance
   • Wage loss benefits
   • Return To Work – When/Who decides this
   • Vocational Rehabilitation (retraining for new career)
   • Psychological treatment
   • Loss of Earnings pension
   • Permanent Functional Impairment (Disability Award)
   • All levels of appeals
2. Disability Management has several key components which includes:
   • Data analysis
   • Disability program design (prevention, claim initiation, claims management, return to regular work, return to transitional work and rehabilitation)
   • Recognition of disability management program importance (e.g. some information on presentation to management, training, communication, etc.) by senior management
   • Measuring outcomes

   A strong element of case management consists of activities that ensure when an employee is off work, he or she is receiving optimal healthcare and focusing on recovery.

   At Elite, we understand that the experience of illness or injury can be overwhelming, impacting individuals and their families. Whether it is occupational or a non-occupational illness or injury, our claims managers are here to help!

   Disability: Our team has extensive experience helping employers manage short-term and long-term disability claims, as well as self insured plans (ASO).

3. Early Involvement is Required: Elite engages the injured employee by beginning the conversations immediately after the injury, so the employee understands the company’s return to work policy and each person’s role in the process – including their own. This allows the employee know what will be expected and can reassure the employee that their employer is committed to helping facilitate a safe return to work. Also, as the statistics show, the less time injured employees are off work, the higher the chances are they will return to work.

   It is very important to get all the resources involved early in the claim so that a plan can be formulated.

   The overall process is driven by an Elite specialist. Early and frequent communications set the tone for cooperation among all parties.

4. Telephone/Virtual Case Management: Elite case management program includes a collaborative process that begins with the first notice of injury. Our experienced case managers are highly skilled in managing, monitoring and/or consulting on WCB claims using medical guidelines to expedite treatment to facilitate a safe return to work(RTW).
5. Return to Work Management: Elite’s claims managers and Return to Work vocational specialists provide immediate and continual return to work management strategies that match individual claim circumstances and complexity. The claims manager always leads the return to work coordination strategy.
6. Physician Advisor: Our physician advisors are called in to support key medical decisions that can significantly impact a claim. They enhance the utilization review process by providing medical and pharmaceutical expertise to ensure clients or employers and their injured employees continue on the right path to achieve the best possible outcomes.
7. Claims Management: Take control of your claims and drive your premiums down. Elite allows you to be in control of your claim costs.

   We bridge the gap between WCB and/or insurance companies and injured workers. How? By guiding injured workers from the start of the claim process. In this way, we maximize the efficiency in moving a claim along and having benefits granted to the injured worker.

   • Keeping employees at work
   • Partner with Telemedicine
   • Telephonic assessments for diagnosis and return to work recommendations
   • Medical triage programs
   • Surveillance teams
   • “Dream Team” – access to medical providers for your staff
   • Focus is on recovery, instead of injury
   • “Boutique” claims management services
   • We come up with customized creative solutions
8. Get an Expert Medical Opinion: When a medical review is needed, it is critical to get a fast, accurate expert medical opinion from an organization you can trust. Elite provides quality physician review services and can easily accommodate short turnaround requests.
9. Return to Work Services: Rapid and efficient return to work coordination is a critical component of any risk management program. Returning to work after an injury or illness can be difficult depending on the circumstances involved. Return to work management requires skillful coordination and persistent intervention.

   Studies show the longer an injured employee is off work, the greater the likelihood that they will become permanently disabled. Consider the statistics below:

   • 10% of people who are off work at 4 weeks after their first date of absence will never return to work
   • 50% of people who are off work at 12 weeks after their first date of absence will never return to work
   • 98% of people who are off work at 52 weeks after their first date of absence will never return to work
10. Driving Positive Outcomes: Successful stay at work and return to work programs are designed to create ways for employees to perform meaningful and productive work as soon as possible following an injury. This offers many benefits to you and your employees including:
    • Reduced overall claim costs
    • Allows the injured employee to continue to be productive and contribute to the company
    • Improves and maintains communications between the employer, the injured employee, and the treating physician, which can lead to a more positive outcome
    • Allows the employer to monitor the employee’s progress, thereby reducing the likelihood of malingering
    • Promotes better morale and retention of valuable employees by reinforcing the employer’s commitment and concern for the injured employee
11. Engaging the Injured Employee: For employers, using a multi-disciplinary team involved in the return to work process is part of a focus on advocacy for the people who make them successful. The primary objective is not just driving return to work or medical cost containment. It is also about connecting with the injured employee and making sure the employee and employer what to expect. Efficient communication across the injury management team builds trust for the employee, as well as a sense of accountability for their own recovery.
12. Our Worker’s Compensation Services: We offer clients the convenience of a single source of service for every kind of absence, which often results in lower costs through greater efficiencies. Our integrated approach allows clients to focus on the bigger picture when it comes to absences. Clients can access one system to obtain all necessary information along the continuum of an employee absence, with integrated reporting on the employee and workforce levels to help measure trends, guide planning and improve productivity.

    We provide the broadest range of services including:

    • End to end claims management solutions
    • Managed care
      1. 24/7 clinical consultation
      2. Telemedicine
      3. TelePT
      4. Utilization review
      5. Telephonic case management
      6. Return to work services
      7. Field case management
      8. Medical bill review
    • Intake and customer service
    • Special investigation unit
13. Focusing on the Outcome: In the quest to control costs and improve outcomes, employers today are exploring a number of options, including unbundling claims and using separate vendors – one for claims processing, one for managed care, etc. We understand the flexibility some customers require, and we support those that unbundle. In fact, we work with more external vendors that any other company in the industry. However, we firmly believe that the more integrated the services, the better the outcome.

    Whether bundled or unbundled, we know that there is ultimately one single claim to manage and those components can’t be viewed as separate or competing elements. They require a singular focus on the ultimate goal – ensuring the best possible outcome for the injured employee at the lowest cost. We provide the level of collaboration necessary to best coordinate all elements of the claim, providing our customers with:

    • Depth and breadth of our industry knowledge
    • Unparalleled access to the industry’s top resources
    • Flexible program design to include the right level of resources by program
    • Exceptional clinical resources including medical directors and other clinicians, who collaborate with the team through every faced of claim resolution
    • Complete team coordination and integration on every claim
    • Execution of strategies we perfected from our industry and jurisdictional experience
14. Doing the Right Thing: Our key objectives include making sure injured employees obtain the best medical care and have an optimal experience throughout the claims process. We accomplish this by concentrating on doing the right thing for the employee in everything we do. We must always stay mindful that something unfortunate has happened that can cause real uncertainty. Therefore, we must approach injured employees in a compassionate way to earn their trust and show them that we are here to help. Doing the right thing in each case includes making sure they have access to quality medical providers for their injury setting expectations, answering their questions, explaining the roles and responsibilities of the team, being responsive and making key decisions as quickly as possible.
15. Beginning with The End in Mind: In today’s market, business requires more than simple claims management. There is a demand to go beyond the basics, to provide a consultative approach on strategies that will ensure compliance while improving efficiencies, outcomes, and overall results. We believe that kind of relationship begins with asking the right questions at the time a loss occurs. This includes looking at psychosocial factors, which may inhibit a prompt return to work, so that the appropriate resources can be applied to the claim when we receive it. Throughout the life of the claim, we look at ways we can provide an effective return to work and ensure jurisdictional compliance. We view every step of the claim process as a critical event where we can work toward achieving the best possible outcome.
16. Focusing on the Future: Elite’s disability management practice provides the expertise, services, and commitment today’s employers demand. We are at the forefront of incorporating and utilizing the latest innovations that can help to improve the claims management process. We are also leading the way in meeting the challenges workplace must adjust to such as new approaches to pain management and ever-changing legislation. Elite stands ready to help employers navigate the complexities of the workers’ compensation claims process.
17. Services:
    • Worker’s compensation claims management
    • Short term disability claims adjudication and management
    • Support for long term/short term disability applications
    • Attendance management & program evaluation
    • Health & wellness initiatives
    • Complex disability management and WCB consultation
    • Independent medical evaluations
    • Occupational therapy and kinesiology assessments and treatment under both long term/short term disabilities
    • Medical rehabilitation
    • Vocational evaluations/assessments & rehabilitation under both long term/short term disabilities
    • Claims cost reviews
    • Relief of cost resources
    • Appeal resources both long term/short term disabilities