Inside Retail Services News

Claims analyst closes long-running case file

Claims analyst Brigitte Le Vie recently closed a prolonged worker compensation case with significant savings for the Retro pool. The case significantly reduced claim costs that helps to control the employer’s future experience factor and Workers’ Compensation insurance premium rates.

The worker in question missed nearly eight months of work due to the injury claims.

The employee of a parts supply company claimed on-the-job wrist and shoulder injuries sustained when she was trying to keep her balance in the back of a moving vehicle. This resulted in the employee taking 44 days off work.

After returning to work for three days, the employee then was granted an additional 182 days off the job by her doctor. Meanwhile, Retail Services worked with the employer to find a suitable light-duty job for the employee.

As Retail Services was trying to resolve the claim, the employee began complaining of carpal tunnel syndrome in her wrist. However, Le Vie challenged the worker’s condition. Le Vie was grappling with a doctor who was fully restricting the worker for minimal objective findings, while trying to convince Labor & Industries to obtain an objective medical opinion that could validly support or deny the claim. Once L&I was convinced to review medical findings of the condition, the claim was denied based on the fact that the employee’s condition was not related to her job duties.

Had the case progressed to corrective surgery, it would have resulted in significant costs to both the employer and the Retro refund pool.

This course of action is typical of the way Retail Services’ experienced team of claims analysts focuses to establish the credibility of claims, which in turn protects both premium refunds to members, and our members’ bottom lines.

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