When a workplace injury occurs, speed is critical. While the administration of emergency medical care should always come first, prompt reporting of the incident to the employer’s workers’ comp insurer is the next important step. The first 24 to 48 hours following an on-the-job injury or illness sets the stage for timely and appropriate medical treatment, anticipated time away from work, return-to-work possibilities, and a more positive claims experience overall.
Rapid reporting enables clear communication among the employer, employee, and insurance company from the start, affirming each stakeholder’s commitment to support an effective recovery for the impacted employee.
In a recent interview with Insurance Business, Jason Volonakis, Complex Claims Director, Lauren Jason, Medical Only/Early Intervention Claims Director, and Lisa Krzywicki, Nurse Case Management Manager - all at Berkshire Hathaway GUARD, came together to discuss best practices for workers’ compensation claims when it comes to rapid reporting, early intervention, and the role of proactive medical management, in alignment with state regulations.
“Those 24 hours after a workplace injury occurs are critical,” explained Lauren Jason. “Early engagement allows us to immediately connect with the employee to begin managing an appropriate medical strategy and confirm our support for the situation – whether minor or complex. Understanding the extent of a disability early in the process also helps us anticipate work restrictions that may be offered by the medical provider. Recovery timelines, which might involve prescription protocols and/or extended rehabilitation, guide us in developing a roadmap for the employee’s eventual return to work, even if it’s in a modified- or light-duty capacity.”
Berkshire Hathaway GUARD’s approach to workers’ compensation claims is unique in that cases are triaged to one of three specialized units: Medical Only, Early Intervention, or Complex Claims. “This model allows us to respond fast to minor incidents while focusing our expert resources on more complicated cases,” said Volonakis.
From a triage perspective, GUARD routes claims based on complexity. By matching each case with the appropriate unit from the outset, GUARD ensures prompt action, specialized attention, and a more effective path to recovery.
“Procedurally, our intake process begins when the claim is reported to us,” added Volonakis. “From there, we have an activation pipeline that's monitored by a registered nurse who is also a certified case manager and assigns the claim to the appropriate unit in support of the best possible outcome. This assignment typically happens within the same day.”
Unlike GUARD’s Medical-Only Unit which focuses on workers’ comp claims that require no time away from work, the Early Intervention Unit (EIU) manages cases in which the employee cannot immediately return to his or her job. The EIU ensures that the injured worker is given timely access to quality medical treatment, while helping to facilitate a safe path for returning to work in line with physician recommendations.
“We work to proactively address treatment concerns, any communication gaps, and potential return-to-work barriers that can ultimately impact the employee’s recovery,” said Krzywicki. “Weekly touchpoints aim to address issues (real or perceived) with the claims handling before escalation, avoiding miscommunication, and fully supporting ongoing recovery efforts.”
GUARD’s medical management* team employs highly trained, registered nurses who help ensure quality medical treatment for injured or ill employees in a timely manner. “It’s all about regular communication between the nurse and the injured worker,” Krzywicki told IB. “We strive to get employees the appropriate treatment from the start, identify potential issues early, and address obstacles before they become barriers to recovery.” Because no two claims are alike, each requires a tailored approach. GUARD’s in-house nurse case management team works proactively to keep injured workers engaged in their care, helping drive better recovery and return-to-work outcomes.
At GUARD, returning to work following an injury or an illness is not viewed as the final step in the claims process. Instead, conversations surrounding this goal are woven throughout the entire path to recovery, whenever possible.
"One of the most important conversations we have early in the claim is around work restrictions and modified duty, if the employee is physically able," explained Jason. "When employees can remain connected to the workplace while recovering, it often leads to better outcomes for everyone involved."
GUARD's claims professionals and nurse case managers collaborate closely with employers to explore transitional work options that accommodate medical restrictions while allowing employees to remain engaged in the recovery process. This approach can help reduce claims duration, support employee morale, and facilitate a smoother transition back to full-duty work when medically appropriate.
“Communication with the employee helps them understand their injury, their treatment plan, and what to expect throughout the recovery process”, added Krzywicki. “When a treatment request falls outside established clinical guidelines, our nurses serve as resources for the injured worker, explaining the medical rationale behind the guidelines and helping them understand the utilization review decision and what it means for their care.”
For the entire GUARD team, their personalized and highly communication-driven approach has been spurred on by trying to counter some misconceptions about workers' comp as an industry. As Jason told IB, “there seems to be this idea sometimes that insurance carriers are the bad guys, which couldn’t be further from the truth. At GUARD, we take our responsibility to our policyholders and their injured or ill employees very seriously. My job is to work hard to get our claimants the care and support they deserve.”
Looking ahead, GUARD's claims team is optimistic about the future of workers' compensation claims, where a people-first approach is not replaced but enhanced by innovative technology and data-driven insights.
As Volonakis explained: “I can see AI and other emerging tools helping claims professionals and nurses access, review, and analyze information more quickly, enabling faster and more informed decision-making which will ultimately benefit all parties.”
"I've always viewed data as an enabler in the claims space," added Jason. "The more information we have, the better decisions we can make. But at the end of the day, it’s still a people-focused process.”
*Managed care for Workers’ Comp is voluntary in some states. Services vary by state and are offered in accordance with all state laws and regulations.
This article was created in partnership with Berkshire Hathaway GUARD
