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Differentiating Lost Time and Medical Only Workers’ Compensation Claims


Even with stringent safety measures, workplace injuries can still occur. Such incidents lead to workers’ compensation claims, categorized as either “Medical Only” or “Lost Time.” Understanding the differences between these claims is essential as both impact an organization’s financial health.

Defining Medical Only Claims

Medical Only claims refer to injuries that require medical treatment but allow the employee to continue working, possibly in a modified role. These claims are generally less costly and less disruptive since the employee does not take significant time off.

Defining Lost Time Claims

Lost Time claims involve more severe injuries that necessitate the employee taking time off work as prescribed by a healthcare provider. These claims are more expensive due to the combination of workers’ compensation benefits and lost productivity. They can also affect the company’s experience modification rate and loss ratios, leading to higher insurance premiums.

Strategies to Prevent Medical Only Claims from Escalating

To avoid Medical Only claims escalating into Lost Time claims, employers can implement several strategies:

1. Direct Injured Employees to Approved Medical Providers
Guide injured employees to healthcare providers familiar with your organization’s return-to-work and light-duty programs. Family doctors may not always be aware of these programs, potentially leading them to impose unnecessary work restrictions. Approved providers can better facilitate a swift and safe return to work.

2. Address Suspected Fraud Promptly
If an injury appears suspicious, inform your claims adjuster immediately. Early detection and investigation of potentially fraudulent claims can prevent them from developing into costly Lost Time claims.

3. Handle All Claims with Care
Treat every claim with importance, regardless of how minor it may seem. Minor injuries can escalate if not properly managed. For instance, an untreated small cut could become infected, leading to more severe complications.

4. Foster a Supportive Workplace Culture
Encourage employees to report injuries and seek medical treatment without fear of negative consequences. A workplace culture that values safety and employee well-being can reduce the occurrence of Lost Time claims and improve overall morale.

The PEC Captive Advantage

Members of PEC Staffing Captive benefit from working directly with industry experts to proactively handle claims. That means getting employees back to work faster after injuries, keeping premium rates stable and businesses running more efficiently. PEC members also have access to peers in their industry, meaning they are afforded insight from other best-in-class organizations on how to manage and prevent similar claims, especially those unique to the staffing industry.

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