But his injuries are reported late. His employees say no one checked on them after they got hurt. Transitional duty never seems to be available in his department. And the claims coming out of his area tend to run longer and cost more.

The team has talked to John about it more than once. Each time, he agrees, apologizes, and promises to do better. And each time, the next claim from his department looks exactly like the last one. Sound familiar? Most employers handle this situation the same way: another reminder, and then another. Here’s why that rarely works, and what to do instead.

Reminders Teach the Wrong Lesson

A reminder with no follow-up sends a clear message, just not the one you intended. When the same expectation is missed repeatedly and nothing changes except another conversation, people learn that the expectation is optional.

This isn’t about John being a bad employee. It’s about the system around him. If your workers’ compensation process lets someone skip key steps indefinitely without consequence, the process is the problem.

Think about any other part of the job. If a manager repeatedly failed to submit required reports, missed safety inspections, or ignored scheduling deadlines, there would be a clear response. Workers’ compensation responsibilities deserve the same standard.

Start With Facts, Not Frustration

Before escalating, confirm that you’re looking at a pattern rather than a feeling. This is where consistent weekly claim reviews pay off.

If you’ve been tracking the same front-end behaviors on every claim, you can look at John’s record objectively:

• How many of his injuries were reported the same day?
• How many first-day contacts happened?
• When his employees were asked, did they confirm someone checked on them?
• How do his claims compare with those from similar departments?

Compare two ways of opening the conversation. “Four of your last five injuries were reported two or more days late” is very different from “People feel like you’re not taking this seriously.” Facts keep the discussion about behavior, not personality.

Figure Out Why It Keeps Happening

Repeat breakdowns usually come from one of four causes, and each requires a different response.

He doesn’t know what’s expected. Maybe he was never trained, or the training happened years ago. The answer is training.

He doesn’t have the tools. Maybe he doesn’t know who to call, where the forms are, or what to say to an injured employee. The answer is simple tools, such as a reporting checklist, a contact script, and a clear list of available transitional duty tasks.

He doesn’t have the resources. Maybe he’s running a short-staffed shift and genuinely can’t step away to handle the process. The answer may be adjusting who handles certain steps.

He knows what to do, has what he needs, and still isn’t doing it. Now it’s an accountability issue, and it needs to be treated like one.

Don’t skip straight to the last category. But don’t stay stuck in the first three forever, either.

Build a Predictable Escalation Path

The most effective approach is an escalation path that everyone understands in advance. It might look like this:

1. Identify the miss in the weekly review and assign a correction.
2. If the miss repeats, provide targeted training or tools.
3. If it continues, involve the manager’s supervisor and document the expectation.
4. If it still continues, elevate it to the executive level as a performance issue.

That final step is why leadership involvement matters. Consequences require authority. An HR coordinator or claims adjuster can remind a manager a dozen times, but they usually can’t change that manager’s performance review. An executive sponsor can. When the path is predictable and applied consistently, escalation stops feeling personal. It becomes part of how the program operates.

Escalation Works Both Directions

The visibility that reveals John’s pattern also reveals the managers who consistently get it right. Think of the supervisor whose injuries are always reported the same day, or the department where every injured employee hears from someone on day one. Recognize those managers. Mention them in leadership meetings, and make their approach the example. Accountability isn’t only about correcting what’s broken. It’s also about reinforcing what’s working.

Stop Reminding. Start Resolving.

If the same name keeps appearing in your claim reviews, another reminder probably won’t change the outcome. Pull the facts, identify the cause, and follow a clear escalation path. Most repeat breakdowns can be fixed. They just can’t be fixed by hoping the next conversation goes differently.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post The Manager Everyone Likes and No One Corrects appeared first on Amaxx Workers Comp Blog.

Quarterly reviews are valuable. They’re where leadership evaluates trends, financial impact, and overall program performance. The problem isn’t the quarterly review itself. The problem is when the quarterly review is the only review.

The Claim Doesn’t Wait for the Meeting

The behaviors that most influence a claim’s outcome happen in the first days after an injury:

• Was the injury reported immediately?
• Did the employee see a provider the same day?
• Did the employer receive work status right away?
• Was transitional duty available?
• Did someone call the employee to check in?

Now consider the timing. Suppose an employee is injured two weeks after your last quarterly review. The injury was reported late, the first-day call never happened, and transitional duty wasn’t offered. Those breakdowns may not be discussed for another ten weeks.

By then, the opportunity has passed. The employee may already be on lost time. They may have spent weeks wondering whether anyone at the company cared, and they may have already called an attorney. The quarterly review can describe what went wrong, but it can no longer prevent it.

Why Quarterly-Only Meetings Get Bloated

When a meeting is the only chance for everyone to coordinate, it has to carry everything. Every open claim needs an update. Every stakeholder needs to attend, because there won’t be another opportunity for three months.

So the meeting fills with status details: the physical therapy schedule, the pending MRI, the date of the next appointment. Those details matter on the individual claim. But they crowd out the conversations a quarterly meeting is best suited for:

• Which locations are struggling?
• Is litigation increasing?
• Is return-to-work performance improving?
• What is this costing the business?

Executives who could be answering those questions end up sitting through appointment updates. Adjusters sit through strategy conversations they don’t need to be part of. Everyone loses time, and the questions that need leadership attention get rushed at the end, if they come up at all.

Patterns Are Hard to See From Memory

Quarterly meetings also struggle to identify patterns, because patterns require information gathered consistently over time.

Suppose no one has been tracking whether each new claim was reported promptly or whether supervisors made their first-day calls. Then the quarterly discussion relies on memory and impressions. “I think the warehouse has been slow to report” is a hunch. “Seven of the last ten warehouse injuries were reported a day or more late” is a pattern leadership can act on.

That kind of clarity only comes from reviewing claims often enough to capture what happened while it’s still fresh.

More Frequent Reviews, Less Total Time

Adding meetings to save time sounds backward. In practice, that’s how the math works.

Weekly. A short weekly review, typically owned by the employer’s internal team, covers only new and active claims. Did the key early steps happen? If not, who is fixing it, and by when? Because it covers a narrow set of questions on a small number of claims, it moves quickly, and it catches breakdowns while they can still be corrected.

Monthly. A monthly review then looks across the weekly notes for patterns by location, department, or supervisor. This is where adjusters and other partners help identify what keeps repeating.

Quarterly. With that groundwork in place, the quarterly review can finally do its real job. Instead of walking through every claim, it focuses on trends, business impact, and the decisions only leadership can make. The meeting gets shorter and sharper, and the people in the room spend their time on issues that actually require them.

Start With One Short Weekly Check

You don’t need to restructure your entire review process at once. Start by adding a brief weekly internal check on new claims. Ask the same handful of questions every time, note every breakdown, and assign an owner to each one.

Within a quarter, you’ll walk into your next quarterly review with something most employers don’t have. You’ll have a clear record of where your process is working, where it isn’t, and what needs leadership attention. That’s when the quarterly review stops being a long status update and becomes the strategic meeting it was meant to be.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post What You Miss When You Only Review Claims Quarterly appeared first on Amaxx Workers Comp Blog.

Fast forward a year.

Injuries are now reported the next day, sometimes later in the week. The first-day call happens when a supervisor remembers. Transitional duty is offered case by case, depending on who is running the shift. Nobody made a decision to stop following the process. It simply stopped being followed.

That’s process drift. It’s one of the most common reasons a workers’ compensation program that once worked well starts producing worse results.

What Drift Actually Looks Like

Drift rarely shows up as a dramatic failure. It shows up as small exceptions that slowly become normal.

A supervisor is short-staffed and waits until the end of the shift to report an injury. Nothing happens. The next time, waiting feels acceptable. A new manager joins and never learns that the first-day phone call is expected. A busy season arrives, and weekly check-ins slide to every other week, then to whenever there’s time.

Each exception seems harmless on its own. The employee still gets treated. The claim still gets filed. But the behaviors that drive good outcomes at the beginning of a claim are the ones that erode first, and those are the behaviors that matter most.

Why Drift Happens

Most drift has nothing to do with people not caring. It comes from three predictable conditions.

Nobody notices the miss. If no one is checking whether injuries are reported the same day, a two-day delay goes unrecorded. The program has no way of seeing its own decline.

Nothing happens after the miss. When a step gets skipped and there is no follow-up, the skipped step becomes the new standard. People learn what is actually expected by watching what happens when expectations aren’t met.

People change. Supervisors move on. New managers arrive. Locations get added. Unless the process is reinforced continually, the knowledge that built the program leaves with the people who built it.

A Few Degrees Off Course

Think about a sailboat crossing open water. A boat that drifts a few degrees off course doesn’t look lost after an hour, and everything feels fine. Over a long voyage, though, those few degrees put it miles from where it meant to land.

Workers’ compensation programs work the same way. A slightly slower reporting habit or a less consistent check-in routine doesn’t feel like a problem this week. Over a year, it shows up as longer claims, more lost time, higher litigation, and costs that seem to rise for no obvious reason.

The fix for the boat is constant small corrections. The fix for your program is the same.

Your Claim Reviews Are Your Drift Detector

This is where regular claim reviews earn their value. A review that only asks about claim status will never catch drift. Status updates describe what is happening on a claim, not whether your process was followed.

Instead, every review should check the same front-end behaviors on every new claim:

• Was the injury reported the same day?
• Was the employee seen by a provider promptly?
• Was work status received right away?
• Did someone contact the employee on the first day?
• Was transitional duty offered when medically appropriate?

Asking the same questions every time is the point, because consistency is what makes drift visible. When one of these answers starts coming back “no” more often, you see it within weeks instead of discovering it a year later on a loss run.

Small Corrections Beat Big Rebuilds

When drift is caught early, the correction is usually simple. It might be a reminder to one location, a quick refresher for a new supervisor, or a clarified expectation about who makes the first-day call. Caught late, drift often requires rebuilding the program. That means retraining everyone, relaunching the process, and trying to undo habits that have had months to settle in.

Every miss identified in a claim review should end with two answers: who owns the correction, and by when. Without those answers, the review documents the drift without stopping it.

Keep the Program Pointed Where You Intended

No program stays on course by itself. The organizations with consistently strong workers’ compensation results aren’t the ones that built a perfect process once. They’re the ones that check, every week, whether the process is still being followed, and they correct small misses before those misses become habits.

Start with your next claim review. Pick the front-end behaviors that matter most, ask about them on every new claim, and write down every miss. Within a few weeks, you’ll know whether your program is still on course or has already started to drift.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post How Good Workers’ Comp Programs Quietly Drift Off Course appeared first on Amaxx Workers Comp Blog.

Yet in many workers’ compensation programs, an investigation can’t start until someone requests it, someone else approves it, and a vendor is scheduled. By the time the investigation begins, much of its value is gone. The fix is making the decision before the claim ever arrives.

Why Case-by-Case Approval Creates Delay

When investigations require individual approval, the adjuster has to recognize the need, explain it, and wait for a response. With a heavy caseload, that request competes with dozens of other priorities.

Meanwhile, the employer may assume the claims administrator will investigate automatically. The claims administrator may assume the employer will ask if they want one. Both sides are waiting for the other. Nothing happens.

Imagine an unwitnessed back injury reported a week after it occurred. The adjuster flags it and emails the employer for approval. The approver is traveling. Approval arrives a few days later, and then the vendor needs time to schedule. By the time anyone speaks with coworkers, their memories have blurred together. The chance to establish clear facts has narrowed.

Decide the Triggers in Advance

A pre-authorized investigation instruction might read:

“The adjuster is authorized to order an investigation of up to a defined number of days, without further approval, when any of the following occur.”

The triggers should be specific and observable. Common examples include:

• The injury was reported late.
• There were no witnesses.
• The employee’s account and the supervisor’s account conflict.
• A manager raises a specific, documented concern.
• The described mechanism of injury doesn’t match the job duties involved.

The exact list will differ by organization. What matters is that the adjuster doesn’t have to guess.Some employers choose a broader approach and authorize investigation on every lost-time claim. Others keep the list narrow to control cost. Either approach can be reasonable. The important thing is making a deliberate decision instead of leaving it to chance.

Write the Instruction Completely

A trigger tells the adjuster when to act. A complete instruction also tells them how.

Consider including:

• Scope: what the investigation should cover, such as scene review, witness statements, or prior claim history where permitted
• Limit: the number of days or dollar amount pre-authorized before additional approval is needed
• Vendor: whether a specific investigation company must be used or may be used
• Start time: how quickly the investigation should begin after the trigger occurs
• Delivery: when the report is due and who receives it

These details keep pre-authorization from becoming open-ended. They also give the adjuster confidence to act immediately, because the boundaries are already set.

Support the Investigator

Pre-authorization only works if the investigator can move quickly once assigned.

The employer plays a direct role here. Investigators often need:

• Supervisor contact information
• Witness names
• Access to the work area
• Job descriptions
• Schedules or time records

Designate one person to coordinate these requests. An investigator who waits days for a return call loses the same ground the pre-authorization was meant to protect.

Investigation Is Fact-Finding, Not Accusation

An investigation clarifies what happened. It shouldn’t suggest that the employer doubts the employee. Most claims are legitimate. When employees sense their employer is treating them with suspicion, trust erodes quickly, and the claim often becomes harder to resolve.

That’s one more reason to define triggers in advance. When investigations follow consistent criteria, they’re less likely to feel personal or arbitrary. The same facts lead to the same response, regardless of who was injured. Investigation practices, especially surveillance, are subject to rules that vary by jurisdiction. Confirm your approach with your claims administrator and counsel.

Then Read the Report

Pre-authorizing an investigation solves half the problem. The other half happens after the report is delivered. Too often, investigation reports are ordered, completed, paid for, and filed without anyone reviewing them carefully.

A report can tell you several things:

• Whether it confirms the employee’s account
• Whether it raises legitimate questions about compensability
• Whether it reveals a safety hazard or process breakdown
• Whether any witnesses need follow-up

None of that helps if no one reads it. If a report won’t be read, the investigation becomes an expense rather than a tool.

Your account instructions should define what happens after delivery:

• Who receives the report
• How quickly it must be reviewed
• Who decides the next step based on the findings
• Where that decision is documented

This is the same discipline that makes any instruction work: a clear decision, a trigger, a timeline, and a named person responsible.

Close the Loop in Your Reviews

Investigations should also come up in claim reviews. Look back periodically at the investigations that were ordered and ask:

• Did the triggers identify the right claims?
• Did investigations start quickly enough to be useful?
• Were findings acted on?

The answers help you refine your instructions and spend investigation dollars where they produce real value.

Final Thoughts

Investigations are most valuable when they happen early and when their findings are used. Deciding the triggers in advance handles the first part. Assigning responsibility for reading and acting on the report handles the second.

Together, they turn investigation from an occasional reaction into a dependable part of your claims management system.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post The Investigation You Paid For Is Only Useful If Someone Reads It appeared first on Amaxx Workers Comp Blog.

No one ignored the instruction. The employer simply didn’t have the authority they assumed they had. This situation is common. It comes down to the difference between two small words: may and must.

Two Very Different Instructions

When an employer tells a claims administrator “you may use this provider,” that’s a consult. The employer recommends, and the claims administrator makes the final decision.

When the instruction says “you must use this provider,” that’s authority. The employer decides, and the claims administrator follows.

Your Insurance Structure Sets the Starting Point

How much authority you have depends largely on your insurance structure.

Control generally increases as employers move from guaranteed cost toward large deductible programs and self-insurance. The more of your own money is paying claims, the more say you typically have in how those claims are handled.

In a guaranteed cost program, the carrier is funding the claims and generally keeps the final say on many decisions. That isn’t a reason to disengage. Guaranteed cost employers still control what happens inside their own organization, including:

• Injury reporting
• Communication with injured employees
• Return-to-work opportunities
• Supervisor response

They can also still ask. The answer may be no, but asking clarifies where you stand.

Where the Distinction Matters Most

Several decisions come up repeatedly in account handling instructions. For each one, you should know whether your instructions say may or must:

• Selection of medical providers
• Selection of defense counsel
• Use of investigation or surveillance vendors
• Use of nurse case management and other managed care services
• Whether to pursue subrogation
• Waiver of liens in settlement
• Claim denials

If you can’t answer the question for a category, that’s where to start.

Write It So There Is No Question

Vague wording creates the confusion. Clear wording prevents it.

Vague: “The employer prefers ABC Law Firm for litigated claims.”

Clear consult: “The adjuster will consult with the risk manager before assigning defense counsel. Final selection rests with the claims administrator.”

Clear authority: “All litigated claims will be assigned to ABC Law Firm.”

Either clear version is fine. What matters is that both sides agree on which one is in place.

The Best Time to Ask Is Before You Sign

Timing matters when negotiating decision rights. A carrier or TPA is usually most flexible while trying to win your business. During selection or renewal, terms that would take months to negotiate later are often agreed to quickly. Changing terms later isn’t impossible, but it’s often more difficult.

Before signing, clarify:

Which decisions belong to you
Which decisions require a consult
How disagreements will be escalated
How often the arrangement will be reviewed

Your insurance broker can be a valuable advocate here, especially if they have experience negotiating account instructions with the carrier or TPA involved.

Don’t Ask for Control You Won’t Use

Authority comes with responsibility. If you insist on approving every counsel assignment, you must respond quickly every time you’re asked. Otherwise, the approval step slows the claim down.

A practical approach is to take authority where you have a clear preference and the capacity to act on it. Allow a consult arrangement everywhere else. Control that sits unused doesn’t improve outcomes. It only adds delay.

Review It Together

Decision rights shouldn’t be set once and forgotten. Use your annual stewardship meeting or quarterly business review to confirm which decisions fall into each category. Talk through situations where the arrangement didn’t work as intended, then adjust.

A consult arrangement that has worked well may be fine as is. An area where you’ve repeatedly disagreed with the outcome may be worth renegotiating.

Final Thoughts

Much of the tension between employers and claims administrators comes from unspoken assumptions about who decides. Two words, clearly written, can remove most of it. Know where you have authority. Know where you have a voice. Put both in writing, and review them regularly.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post “May” vs. “Must”: The Two Words That Decide Who Controls Your Claims appeared first on Amaxx Workers Comp Blog.

The problem is that values don’t tell an adjuster what to do on a Tuesday afternoon with 200 open files and a phone that won’t stop ringing.

An adjuster working several employer accounts is following several sets of instructions at once. The instructions that get followed are the ones that remove guesswork. The ones that get skipped are the ones that require interpretation.

A simple way to close that gap is to test every instruction against four questions:

• What decision has already been made?
• What triggers this action?
• How quickly must it happen?
• Who needs to be notified?
  

Click Link to Access Free PDF Download

“How Do I Get My Adjusters To Follow My Account Handling Instructions?”

The first question usually gets the most attention. Replacing “we support return to work” with “modified duty will be offered within 24 hours of receiving work restrictions” turns a philosophy into a decision. A decision alone isn’t enough, though. The other three questions are what make it usable in practice.

Triggers: When This Happens, Do That

A trigger is a clear event in the life of a claim that starts a specific action.

Workers’ compensation claims follow predictable patterns:

• Indemnity benefits continue past a certain number of days.
• Costs cross dollar thresholds.
• Surgery is recommended.
• An attorney letter arrives.
• The employee stops attending appointments.

Each of these is a mile marker. Instructions are much easier to follow when they’re tied to mile markers rather than general expectations.

Compare these examples:

• Weak: “Complex claims should receive additional attention.”
• Strong: “If indemnity benefits extend beyond 14 days, schedule a claim review with the employer’s workers’ comp coordinator.”
• Weak: “Surgical cases should be monitored closely.”
• Strong: “Upon receipt of a surgery recommendation, notify the employer and evaluate the need for a nurse case management referral.”

The adjuster doesn’t have to decide whether a claim is “complex.” The trigger decides for them. When you review your instructions, look for words like significant, complex, appropriate, or as needed. Each one usually signals a missing trigger.

Timelines: How Quickly It Must Happen

A trigger without a timeline still leaves room for delay.

“Contact the employer when surgery is recommended” is better than nothing. “Contact the employer within one business day of a surgery recommendation” is something an adjuster can plan around and something you can measure.

The most familiar example already appears in nearly every set of instructions: three-point contact with the employer, the injured employee, and the medical provider within 24 hours. It works because the expectation is specific.

Apply that same standard elsewhere:

• Response time for emails and phone calls
• Filing of required state forms
• Initial reserve setting
• Referral to nurse case management after a defined trigger
• Follow-up after a return-to-work release

Timelines also make accountability fair. When expectations are specific, a review conversation becomes objective. Either the standard was met or it wasn’t. No one has to argue about what “promptly” was supposed to mean.

Notification: Who Needs to Know

The fourth question is where many instructions break down.

“The employer must be kept informed” sounds reasonable. In practice, it tells the adjuster almost nothing. Informed about what? By whom? Before or after the action?

Here’s a stronger version: “The risk manager must approve any reserve increase that would bring total reserves above $50,000 before the change is made.”

That one sentence contains a threshold, a timing requirement, and a named role. Your dollar amount will differ, but the structure is what matters.

Notification instructions should answer:

• Which role must be contacted, by title and name
• Whether notice comes before or after the action
• Whether the contact is informational or requires approval
• Who the backup is when the primary contact is unavailable

That last point deserves attention. An approval requirement is only as good as the person responsible for approving. If the adjuster needs your sign-off and can’t reach you, the instruction creates delay instead of control. Delayed claims tend to stay open longer, and longer claims cost more.

Putting the Four Questions to Work

You don’t need to rewrite your instructions from scratch. Start with the version you have now. Take each instruction and ask the four questions. Where an answer is missing, add it. Where an instruction relies on vague language, replace it with a specific trigger or timeline.

Many employers find they can keep their existing philosophy almost entirely intact. They simply make it clearer, more concise, and easier to act on. Then share the revised version with your claims partner. Ask the adjusters handling your files where they get stuck. They often know exactly which instructions cause confusion.

Final Thoughts

Adjusters follow the instructions that are easiest to follow. Every trigger, timeline, and notification rule you define removes one more decision they would otherwise have to make on their own.

That is how account handling instructions stop sitting in a file and start shaping how your claims are actually handled.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post How to Test Every Line of Your Account Handling Instructions appeared first on Amaxx Workers Comp Blog.

This is the apples-to-oranges problem that trips up a lot of employers shopping for telemedicine or nurse triage vendors. The headline price rarely tells you what you are actually buying.

Why the Same Number Can Mean Different Things

A $100 call handled entirely by a registered nurse, using a clinical algorithm to direct self-care or refer to a clinic, is a very different service than a $100 call that connects an employee to a live physician who can prescribe treatment and issue return-to-work status on the spot. Both are valid services. Neither is inherently better. But they are not substitutes for each other, and comparing their prices side by side without understanding what each includes leads to a decision made on the wrong basis.

Vendors are not always eager to make this distinction clear in a sales conversation. It is the employer’s job to ask.

Questions About the Clinical Model

Who actually answers the call: a nurse, a nurse practitioner, or a physician? If it starts with a nurse, what triggers an escalation to a higher level of care, and how fast does that handoff happen?

Can the person on the call authorize treatment, write a prescription, or issue return-to-work status, or do they only provide guidance and a referral?

What percentage of calls typically resolve through self-care alone, based on the vendor’s own historical data? A vendor who cannot answer this with real numbers may not be tracking outcomes closely.

Questions About Pricing Structure

Is the price per call, per employee per month, or a blended rate across all injury types? Each structure creates different incentives, and it is worth understanding which one you are agreeing to.

Does the price change based on time of day or day of the week? Some vendors charge more for nights, weekends, or holidays. If your workforce operates around the clock, this matters significantly.

Are there additional fees for follow-up calls, documentation, or reports sent to your claims team? A low headline price can hide costs that show up later in the relationship.

Questions About Coverage and Access

Does the vendor have coverage in every state and region where you operate? A vendor that works well in your headquarters city may have limited physician availability in a rural location or a newly acquired facility. Ask specifically about any location where you know coverage could be thin.

What is the actual average wait time to connect with a provider, not the marketed wait time? Ask for real data, not the number in the sales deck.

Questions About Outcomes and Accountability

How does the vendor measure success? Self-care rate, time to first contact, and claim avoidance are all reasonable metrics, but the vendor should be able to name specific ones and share how they track them.

Will the vendor provide claim-level or aggregate reporting that shows how their service is performing for your specific workforce, not just industry-wide statistics?

What happens when the nurse or physician on the call is uncertain about the right next step? Understanding the vendor’s escalation protocol for ambiguous cases tells you a lot about how conservative or how efficient their model is designed to be.

Putting It Together Before You Sign

Once you have answers to these questions, build a simple comparison that separates clinical model from price. List what each vendor’s price actually includes: who answers the call, what they can authorize, how fast escalation happens, and what coverage looks like in your specific locations. Only then compare the numbers.

This approach protects against the most common mistake in vendor selection: assuming that the lowest price per call is the best value. A nurse-first program priced lower than a physician-first program is not automatically the better deal. It depends entirely on whether your injury mix and your workforce’s needs match what that lower-priced model is actually built to deliver.

The Bottom Line

Telemedicine and triage pricing can look deceptively simple on a proposal, but the services behind the price vary widely. Employers who ask the right questions before signing avoid the surprise of discovering, months into the relationship, that they bought a service that does not match what their workforce actually needed. A few focused questions upfront save far more than they cost.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post What to Ask Before Signing With a New Telemedicine or Triage Vendor appeared first on Amaxx Workers Comp Blog.

This is the practical follow-up. Not why to move away from discounts, but how.

Start With Your Own Data

Before any conversation happens, gather the numbers. Pull claim duration, return-to-work rates, and total cost per claim for your top providers over the last one to two years. Compare providers against each other, not against an industry average. You are looking for the provider whose discount looks good on paper but whose claim outcomes lag behind.

This step matters because the conversation you are about to have works best when it is grounded in your own results, not in a general argument about discount economics. A provider who hears “your discount is fine, but your claims run 20 percent longer than our other clinics” is hearing something specific and measurable. A provider who hears “we think discounts are bad” is hearing an opinion.

Decide What You’re Actually Asking For

Before reaching out, be clear about the ask. It is rarely “give up your discount for nothing.” It is closer to: “We will pay you full fee schedule. In exchange, we want faster same-day reporting, direct communication with our claims team, and a commitment to understanding our modified duty options.” The discount was never really about price. It was a proxy for volume. Full fee schedule paid consistently, with real engagement, can be worth more to a provider than a discounted rate tied to inconsistent referrals.

The Conversation Itself

When you sit down with the provider or the clinic’s administrator, a simple structure works well. Open with the relationship, not the money. Explain that you want to build a stronger partnership because their clinic already handles a meaningful share of your claims, and you want that relationship to work better for everyone involved, including the injured employee.

Share the data. Show them what you’re seeing in claim duration, communication turnaround, or return-to-work timing. Keep it factual and specific. Avoid framing it as a complaint. Make the offer. Explain that you are willing to move them to full fee schedule if they commit to specific, measurable behaviors: same-day work status notes, a direct line to your claims or safety team, and participation in occasional job-site visits so they understand the physical demands of your roles.

Ask what they need from you. A stronger partnership runs both directions. The provider may need better job descriptions, faster access to your claims team, or clearer expectations about modified duty availability. Find out and commit to it. Set a review point. Agree to revisit the arrangement in two or three months using the same data you opened with. This turns the conversation into an ongoing relationship rather than a one-time negotiation.

What to Do With Your TPA

If a TPA or network administers the relationship rather than you directly, the conversation looks slightly different. You are not asking the provider to change their rate structure with the network. You are asking your TPA to carve out a direct arrangement for that specific clinic, sometimes called a bill review exception or a direct-pay agreement. Be explicit that you understand this may mean paying more per bill for that provider, and that you have already determined it is worth it based on your own outcome data.

Some TPAs will resist this because it complicates their standard network reporting. Hold firm if the data supports it. It is your program and your cost, and the TPA’s administrative convenience should not override a change that improves outcomes.

What Success Looks Like

You will know the renegotiation worked when the provider’s communication improves noticeably within the first few claims. Same-day work status notes stop being the exception. Modified duty conversations happen without prompting. The provider starts calling you proactively about claims that are drifting off track, rather than waiting for your team to notice. If none of that happens within a reasonable window, the conversation was not really about discounts in the first place, and it may be time to look at a different provider.

Starting Small

Employers do not need to renegotiate every provider relationship at once. Start with the one or two clinics that handle the largest share of your claim volume. Prove the model works there, then expand it. A structured, repeatable approach beats trying to overhaul the entire network in one push.

The Bottom Line

The shift from discount-driven networks to performance-driven partnerships is not a policy statement. It is a series of specific conversations, backed by specific data, with specific asks. Employers who treat it as a step-by-step process, rather than a one-time negotiation, build provider relationships that actually change claim outcomes.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post The Conversation That Changes Your Provider Relationship appeared first on Amaxx Workers Comp Blog.

Many employers assume “telemedicine” is a single, interchangeable service. In practice, it splits into two distinct intake models. Understanding the difference helps employers pick the one that fits their workforce, their injury mix, and their return-to-work goals.

The Nurse-First Model

In this model, a trained triage nurse is the first point of contact. The nurse asks a structured set of questions, follows clinical protocols, and determines the right next step: self-care instructions, a referral to a clinic, or an escalation to a telemedicine physician or emergency care.

This model works well for high injury volume. A nurse can efficiently sort a wide range of complaints, from minor strains to more serious concerns, and route each one appropriately. It also tends to be the lower-cost option per call, since a registered nurse’s time costs less than a physician’s.

The tradeoff is that a nurse cannot diagnose, prescribe, or authorize treatment. For anything beyond basic guidance, the nurse hands off to another provider, which adds a step. For employees with straightforward injuries, that handoff is barely noticeable. For employees who need a clinical decision quickly, it can add friction.

The Physician-First Model

In this model, the injured employee is connected directly to a physician for a live video or phone consultation, often within minutes. The physician can evaluate the injury, provide treatment guidance, and issue return-to-work status on the spot.

This model removes a layer of handoff. The employee gets a clinical decision in one call instead of two. For injuries that commonly need medical judgment right away, such as lacerations, possible fractures, or eye injuries, this can shorten the time between injury and treatment decision significantly.

The tradeoff is cost. Physician time costs more than nurse time, and not every injury needs a physician-level evaluation. Routing every call directly to a physician can mean paying for clinical judgment on cases a nurse could have resolved with simple self-care instructions.

Why the Choice Matters

Comparing the price of a nurse-first program to the price of a physician-first program is not an apples-to-apples exercise. They are different services solving different problems. Evaluating them purely on cost per call misses what each model is actually built to do.

The better question is not “which is cheaper,” but “which matches how our injuries actually present.” An employer with a large, dispersed workforce and a high volume of minor strains and sprains may get more value from a nurse-first model that filters efficiently and keeps costs predictable. An employer with higher-risk operations, where injuries are more likely to need an immediate clinical decision, may find that a physician-first model reduces delay and gets employees the right answer faster.

Some vendors offer a hybrid: nurse triage as the front door, with a fast, built-in escalation path to a physician when the nurse’s protocol calls for it. This combines the cost efficiency of nurse-first screening with the clinical authority of physician-first care. It is worth asking any vendor whether this option exists.

Questions to Ask When Choosing

Before selecting a telemedicine or triage vendor, employers should ask:

What percentage of typical claims would likely resolve through self-care alone?

How quickly does the nurse-to-physician handoff happen, if one is needed?

Does the physician on the call have return-to-work authority, or only initial treatment authority?

How does the vendor measure success: self-care rate, time to first contact, or claim avoidance?

The answers should shape the decision, not the marketing pitch.

The Return-to-Work Connection

This decision is not just about cost containment. It is a return-to-work decision made in the first minutes after an injury. A model that gets an employee a fast, accurate clinical answer supports earlier, appropriate return-to-work planning. A model that adds unnecessary delay, or one that routes minor injuries through an expensive physician call out of habit rather than need, works against that goal, either by slowing things down or by driving unnecessary cost.

Employers should also consider workforce geography. A dispersed or remote workforce may lean toward a model with the broadest possible physician availability, since local urgent care access can be limited. A concentrated workforce near quality clinics may not need that same level of physician immediacy through telemedicine, since in-person care is close by either way.

The Bottom Line

There is no universally correct answer between nurse-first and physician-first telemedicine. The right choice depends on the nature of the work, the typical injury mix, and how quickly a clinical decision needs to happen once the call connects. Employers who match the model to their actual injury data, rather than defaulting to whichever program a vendor sells hardest, end up with a program that controls cost and supports faster, safer return-to-work outcomes.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post Beyond “We Offer Telemedicine”: Choosing the Right Intake Model appeared first on Amaxx Workers Comp Blog.

That number matters, but it tells you almost nothing about what is actually happening inside the organization day to day. For that, you need something else entirely: a reporting system that functions as a genuine feedback loop, not just a form that gets filed away.

Why the Injury Count Alone Is Misleading

A low injury rate feels like good news. Sometimes it is. Other times, it means something less comforting. Employees have simply stopped reporting. Underreporting does not show up as a red flag. It shows up as quiet. Numbers look fine. Meetings feel calm. Then, months later, a claim surfaces that traces back to a hazard everyone on the floor already knew about.

This is the core problem with relying on lagging indicators alone. They tell you what already happened. They tell you nothing about what is building underneath the surface right now.

What a Reporting System Is Actually For

A reporting system exists to capture information before it turns into an incident, not just to document one after the fact. Done well, it becomes the closest thing an organization has to a nervous system, carrying signals from the floor to the people who can act on them.

That signal only travels one direction if the system works. Employees notice something. They report it. Someone reviews it. Someone acts. And critically, someone communicates back what was done. Break any link in that chain and the system stops functioning, even if the reporting form itself still gets used.

Where Reporting Systems Usually Fail

The failure point is rarely the paperwork. Most organizations have some version of a hazard reporting process already. The failure happens in what follows. An employee reports a concern. It gets logged. Then it disappears into a queue with no clear owner and no expected timeline. Weeks later, the employee notices nothing has changed. They do not necessarily complain. They simply stop reporting the next thing they notice, because the last report seemed to go nowhere.

Multiply that experience across a workforce and you get an organization with a technically functioning reporting system and a workforce that has quietly opted out of using it.

The Trust Problem Hiding Inside the Data Problem

It is tempting to treat this as a process issue, something that can be fixed with a better form or a faster review cycle. The deeper issue is trust. Employees will only feed a reporting system honestly if they believe two things. That reporting will not create a problem for them personally, and that reporting will lead to something changing. Remove either belief, and the flow of real information slows to a trickle, no matter how well designed the intake process looks on paper.

This is why reporting systems cannot be evaluated on volume of submissions alone. A spike in reports after a new initiative might mean growing trust. It might also mean a backlog finally surfacing after years of employees holding back. The number by itself does not tell you which.

Building a Reporting System That Actually Works

A functioning system needs three things. It needs to be easy to use, so employees are not discouraged by a complicated process in the middle of a busy shift. It needs visible ownership, so a report does not vanish into an inbox no one checks. And it needs a feedback step, where employees are told what happened as a result of what they reported.

That last piece is the one most often missing, and it is the one that determines whether the system builds trust or slowly erodes it. Telling an employee that a hazard was fixed, or explaining honestly why a fix will take longer, costs almost nothing. Skipping that step costs the organization the willingness of employees to speak up the next time.

A Practical Starting Point

Review your current reporting process with one specific question. When was the last time someone reported something and later found out what happened as a result? If that answer is unclear, or if it typically is not communicated back, that is the gap to close first. Not a new form. Not a new software platform. A simple, consistent habit of closing the loop.

A reporting system is not a filing cabinet for hazards. It is a feedback loop, and feedback loops only work in both directions. Build that loop well, and small problems get caught and corrected before they ever become a claim. Leave it broken, and the organization finds out about its risks the expensive way, one incident at a time.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post What Your Reporting System Reveals About Your Actual Safety Culture appeared first on Amaxx Workers Comp Blog.