Though large, self-insured companies have been using it for years, pre-claim nurse triage has not yet been wholeheartedly embraced by workers’ compensation carriers.

The Claims Journal article quotes Brian Cullen, managing director of Triage for Medcor, an outsourcing triage service. “Claim people are so sure that they have everything done with the claim, but they don’t quite get pre-claim first aid screening, which all the big companies have already proven works great for the 17 years we’ve been doing it. It’s fascinating to watch an industry wake up to this best practice.”

According to Cullen, Medcor works with about 15 carriers now and says it’s still in the very early stages of the adoption curve. Captives have embraced pre-claim nurse triage while state funds have also been slow to adopt the system. He said a nurse answers the phone directly and after obtaining a name and location will begin series of questions on defining the injury. The system can handle multiple injuries due to a patent the company has that enables parallel triaging of multiple injuries simultaneously.

Medcor pioneered telephonic triage, according to Cullen. “We literally now have taken 1.7 million phone calls in 17 years, and we’re taking about a thousand a day with a call center staffed with RNs,” said Cullen. “We have algorithms that we’ve homegrown, we own our own software company,” he said. Initially, the nurse will try to rule out a call to 911. “Literally, one percent of all calls we take result in a recommendation of 911,” Cullen said.

One insurer that sees benefits in using early claims triaging is Secura. “We have been doing it since late 2011. We were fully engaged with it by about the middle of 2012,” said Tony Brecunier, director of workers’ compensation for Secura. “We had some of our agents who had a 24/7 nurse triage on some of their program accounts, and were telling us that they were seeing benefits of lesser claims reported, better reporting, lower lag time reporting.”

“We have seen a reduction in all types of situations,” the workers’ comp director said. “While it’s hard to measure – we know that when we look at the calls that are made to the 24/7 triage – about 42 percent of those folks go back to work without ever making a claim,” said Brecunier.

The advantage of a nurse hotline, he said, is that the injured worker knows he or she is speaking with a medical professional who can provide reassurance that a back strain will typically resolve in a day or two and if it doesn’t then further treatment can be sought. Though Brecunier can’t say for sure that it has limited fraud in Secura’s program, Cullen said pre-claim triage has the potential to reduce fraudulent workers’ compensation claims.