Claim Adjudication And Management Case Study

How do employer priorities affect claim adjudication and management in workers’ compensation systems?

A company’s main priority is being successful by making a profit. The global market is becoming more competitive and as a result, many businesses adopt strategies that cut costs to ensure that they do not run bankrupt. When employees are injured, the potential cost of injury claims impacts a company’s WCB premiums. Workers compensation boards are responsible for adjusting the company’s premium based on its injury prevention performance, but not on the industry’s average. A company’s performance compared to the industry’s average determines whether employers receive a surcharge or are awarded a rebate. The workers compensation board uses rating

The program is keeps injured workers involved in work-related duties in the workplace, address potential moral hazards, support workers in their rehabilitation as they gradually engage in their duties fully, and minimize the company’s WCB claim costs. However, it is oversimplified and can lead to the rise of problems, especially when employers keep legitimate lost-time claims off company records and become more aggressive in claim management strategies. In an effort to manipulate the workers’ compensation system, employers offer injured workers light duties to show the WCB that they offer modified work and later engage the injured workers in meaningful work after they fully recuperate. Moreover, this strategy is essential and relevant because offering aggressive duties to injured employees is hazardous to their health. Workers feel they are working under pressure and under conditions that are beyond their capabilities. This impacts their mental and physical health, diminishing their ability to return to work

Stigma is the public disapproval and an association of disgrace that becomes apparent when an injured employee experiences unethical or insensitive treatment and negative stereotypes. Negative stereotypes such as defrauding the system, laziness, and poor work ethics are troubling to workers whose injuries cannot be noticed openly. Injured workers feel guilty, humiliated, and isolated as doubt and judgement are expressed by their co-workers, family members, employer, and WCB case workers. Effects related to stigma can be lessened if injured workers can get support from knowledgeable individuals involved in the compensation process. Since claims are adjudicated individually, injured workers are unable to understand their injuries and lack the opportunity to interact with other individuals who have similar experiences. Additionally, they suffer from imbalance of power and stigmatization and the only solution is to receive support and technical assurance from people in powerful positions to lessen their sense of