Comp Low Hanging Fruit – Simple Med Only Claims


We approach the handling of simple medical only (SMO) claims with the same level of intensity that we approach traumatic/catastrophic injuries.  Our RN Case Managers:

  • Quickly contact the employee, treating physician and employer.
  • The medical records are obtained and an initial investigation is conducted.
  • The following determinations are critical to managing the case
    1. Does the employee understand and are they willing to comply with medical instructions?
    2. Are they back to work? If not, when?
    3. Do any of the parties feel additional medical follow up/prescriptions/job accommodations are needed.
    4. Are there contributing factors, prior incidents or comorbidities that warrant assignment of more intensive case management.

When these determinants correctly fall into place, the case should be quickly resolved with a minimum of medical expense and no disability payment.  When these SMOs are ignored or when one of these determinants is insufficient, a red light should go on and the care should be more intensely managed.

After 30 years of managing over 200,000 medical cases, I feel like the Russian Director Stanislavsky who said, “there are no small parts, only small actors”.  In my experience, “there are no simple claims, only uncontrolled claims waiting to explode”.

Call Us.  We can do better.

William V. Faris, JD
Chief Executive Officer

Posted in Group Benefits Programs