How to Know If A Claim Is “Ready” for Mediation

Written By

Like all claims management tools, there are several circumstances in a claim that make it well postured for mediation.

The same way there are circumstances that point us towards vocational rehabilitation or an IME, there are also circumstances that indicate a claim is ready for mediation.

Claims managers, adjusters, risk managers, attorneys, etc, are well trained in the implementation and use of claims management tools like nurse case managers, surveillance, SMOs, voc rehab, and the like. We work with very competent claims adjusters and attorneys every day who are excellent at what they do and can effectively recognize the circumstances that call for each of the aforementioned tools.

In fact, it seems we’ve become so good at using these tools that what injured workers and employers are really seeking in a comp claim—closure— sometimes can get lost in the mix. These tools should be utilized in many cases, no doubt, but maintaining a focus on the ultimate goal can prevent a claim from falling into autopilot.

Mediation offers a possibility that no other claims management tool does: resolution, case closed. 

Often thought of as a last ditch effort, mediation is a tool that, when used sooner rather than later, actually:

  • delivers what employers and insurers want: closure

  • mitigates case load for case managers

  • greatly impacts the lives of real people for who may be stuck in the comp system

In the same way there’s a time and place for SMOs and surveillance, there’s a time and place for mediation, and it might differ from what we’ve learned in our training.

After 6,000+ mediations and 25+ years in the workers’ comp field, we’ve compiled the following list of criteria that cases which are ripe for mediation meet.

  • at MMI or expected within 6 months

  • settlement request

  • indemnity payments ongoing for at least 2 years

  • plaintiff counsel or treating physician involvement

  • treatment on “auto pilot”; no change in sight

  • return to job of injury unlikely due to age and/or restrictions

  • Medicare or MSA required or probable

  • active litigation

  • jurisdiction or venue considerations

  • Second Injury Fund involvement (mediation prior to approval)

  • permanent and total disability

As you work through your file list and help injured workers and employers navigate their claims, we invite you to look at this list and see what claims meet this criteria.

If you find a claim that seems appropriate, simply give our office a call or email us and we can walk you through the next steps of getting a mediation on the books and giving you a 90% chance of doing what’s best for all parties, and your team: closure.

Next

Choosing Tomorrow