Telehealth for Workplace Disability Claims
Windley Ely’s National Nurse Triage program is the only one of its kind in Canada. We adhere to best practice Nurse Triage protocols, to ensure optimum service for you and your employees. Nurse triage can be bundled with any of Windley Ely’s Occupational Claims Management programs.
How Does Nurse Triage Work?
1
As soon as an employee is injured, the employee or employee’s supervisor phones the Windley Ely Nurse Triage Telehealth toll-free number, which is staffed by qualified Registered Nurses (RNs) 24 hours a day, 7 days a week.
2
The call is answered by a teleprompt that notifies the employee or supervisor that the call is monitored for quality assurance (QA) and asks them to hold the line for a Nurse.
3
Following a brief introduction, the triage Nurse obtains medical consent from the employee and proceeds to collect information regarding diagnosis and other pertinent information and enters it into the Clear Triage software.
4
Based on their own experience and medical knowledge, the triage nurse dispenses appropriate care advice, within Schmitt-Thompson Protocols. The triage nurse then determines whether the incident can be monitored/maintained as a First Aid claim or whether the employee should be directed to a Doctor to get medical care (Medical Aid Claim).
Triaging a First-Aid Claim
If deemed a First-Aid Claim situation, the Triage nurse will set it up accordingly in WE Claims™ software and notifications of the claim are sent to the appropriate Health, Safety and Environment (HSE) and Human Resource management personnel.
The Triage Nurse sets a bring forward date within the WE Claims system to call the employee the next day. The Nurse will establish daily contact with the employee and send email notification updates to the distribution list as required, or until the file is closed as a Full Return to Work (FRTW).
If at any time the Triage Nurse determines that the employee should be directed for medical care the claim is transferred to a Medical Aid Status accordingly.
Triaging a Medical Aid Claim
In the event that an injured/ill employee requires external medical attention, the Triage Nurse sends an Email notification to the relevant HSE/HR personnel and to the Windley Ely Case Team, advising them that the employee will be seeking medical attention and that a claim will need to be filed to the appropriate Workers’ Compensation Board (WCB).
For Windley Ely Total Claims Management clients, the claim is seamlessly integrated into our Medical Management program. Windley Ely Nurses, Physicians and Case Managers facilitate the speedy recovery of the injured employee and hold the insurance and medical community accountable to optimal claim outcomes.
Why Nurse Triage?
Minimizes the need for employees to seek 3rd party medical care in cases where it is medically deemed unwarranted/inappropriate.
Reduces the number of medical aid, restricted work and time loss claims incurred when an injured employee sees a doctor for a minor injury that could otherwise have been maintained as a straight forward first-aid claim with nurse follow up/intervention.
Helps ensure that the employee is directed to timely medical care when required. Too often employees refuse or delay seeking initial medical attention. Without early Nurse intervention these claims can escalate into more serious injuries.
Eliminates the burden on supervisors who otherwise need to determine whether or not to direct the employee to medical and under what circumstances.
Telehealth Reporting
Incoming Telehealth calls are routinely monitored for quality-assurance purposes, to ensure best practices are followed throughout the process. We will provide you with quarterly reports, so you can review the effectiveness of the program. With each report, you’ll be able to view the underlying performance metrics, including:
• Call Volumes
• Originating Call Locations
• Call Types – First Aid vs. Medical Aid
• % Claims Transferred from First Aid to Medical Aid Status
• % Claims maintained as First Aid Claims
• Ratio of claims reported during regular business hours vs. after hours
• Miscellaneous other reports as needed
Windley Ely is able to improve your workers’ compensation claims management by striving to outpace our peers in 5 key areas:
Unmatched Service
Challenging Entitlement
Minimizing Lost Time
Cost Relief and Cost Transfer
Account Management
We take a holistic approach to workers’ compensation, with a sharp eye for cost management and workplace productivity. Our end-to-end managed service model provides superior claims management at a lower price than your current solution.
