Glossary · PA Workers' Comp

Claims Management

The process of actively managing workers' comp claims from first report through resolution to minimize costs and protect the experience modifier.

Definition

Claims management refers to the active involvement of an employer — or their broker or TPA — in monitoring, directing, and resolving workers' compensation claims to achieve timely recovery for injured workers and minimize total claim costs.

Active Claims Management: Steps That Reduce Costs from Day One

Effective claims management begins before an injury occurs: establishing relationships with occupational health providers, training supervisors on proper injury reporting, and having a return-to-work program ready to implement.

When a claim occurs, key steps include: same-day report to the insurer, facilitation of immediate medical care, supervisor contact with the injured employee, and assessment of modified duty options.

Employers have the right to direct medical care for the first 90 days following a work injury in Pennsylvania. This right to direct care allows employers to send injured workers to occupational health providers who understand workers' comp return-to-work requirements, rather than emergency rooms.

Working with a knowledgeable insurance broker who provides claims advocacy — not just policy placement — can significantly reduce total claim costs through proper insurer oversight.