VSDP and Workers’ Compensation Kitty Hughes Workers’ Compensation Services

Program Overview GOAL STD claims -Provide agency with VSDP coordinated approvals on occupational cases. LTD claims – Provide IWs with direct LTD benefits and supplemental benefits on occupational cases.

Reporting the claim Workers’ Compensation MC Innovations –Submission via Visual Liquid Web by agency representative –Mandatory submission by day 10 post injury VSDP Reed Group –Submitted by member or anyone on their behalf –14 day look back from date reported

Workflow Process New claim process Pending claim process Ongoing approval process Denied claim process

New Claim – WC/VSDP Agency submits WC claim via VLW Benefit Coordinator initiates WC investigation IF IW initiates claim with Reed Group –Reed Group sends Althea an for information Enters Reed Claim Number in WC system Notes eligibility VSDP File (Yes) field places DBS in responsibility tab sets a diary for the BC Enters a VSDP note in the claim system Report generates to assigned DBS next business day

Althea adds Reed Claim Number

Adds VSDP Filed - Yes

Disability approval updated

Add the DBS Name

Sets a diary for follow up

Pending claim process Weekly review of WC file status on diary WCS notifies Althea if comp decision is made in between diary dates Althea updates the VSDP status via VSDP file note (for overnight transmission) Reed processes disability claim while WC Claim remains in a WC Pending status

Ongoing disability approvals Disability approvals are scheduled by: –BC or Althea –Based on the next treating physician’s office visit (NOV) –Anticipated length of disability –Claims activities on file (such as IME, surveillance or vocational compliance)

Denied Claims Denied claim compensability – reported to Reed Group via VSDP daily report Denied ongoing approvals based on: Settlement of claim Failure to cooperate Refusal of medical Disability from unauthorized physician

Communication is the key Accurate facts Opportunities/options Optimal medical outcomes RTW facilitation

Agency Interaction Knowledge of process Who do you contact? –Workers’ Compensation Althea Burnett (804)

What you can do to help Provide RTW updates to both TPA’s Provide Wage and Supplemental Reports Encourage IW to report claim to Reed Group timely Forward medical notes/disability slips Track and share LTD date Contact TPA if approval is inaccurate

Goal – Universe in Harmony