Our Claim Process
From first report through the return to work process and management of any controverted claim, we help control workers compensation costs and improve outcomes for injured workers. We are at the industry forefront in developing new programs that make an impact both short- and long-term, and we invite you to learn more about our claim management program,
Caring for the Injured Worker
At A.I.M. Mutual, we understand how devastating an at-work injury can be, both physically and emotionally. We are at the forefront in expediting quality care to employees injured on the job and in helping to manage all aspects of their treatment.
At the same time, we know injured workers have other concerns on their minds. They may worry about their job status and how they will pay their rent or mortgage, utilities or food bills. We address these issues at the outset, and periodically as needed, to make this process as easy as possible. We have temporary fill pharmacy cards that allow injured workers to obtain their prescriptions while the accident investigation is ongoing. We make prompt determinations on whether a claim is compensable, and if so, quickly put the appropriate services in place.
These services may include enlisting our Patient Advocates to help employees navigate the health care process so they can obtain the treatment they need. We provide access to Best Doctor Occupational Health Institute specialists, who review and facilitate care, as well as to specialists who can advise employees on proper durable medical equipment. We work with all parties involved to return the injured worker back to the workplace as soon as it is safe and appropriate for him or her to do so. We have a staff of highly trained and experienced adjusters to work closely with employers through the duration of an on-the-job injury.
For your reference, here are answers to some frequently asked questions from injured workers.
Employee Injury Overview FAQ
A.I.M.Works is a combination of several highly effective programs unique to A.I.M. Mutual Insurance Companies:
- Medical Care Improvement Initiative
- Pharmacy Benefit Management Program
- Stay at Work/Return to Work Program™
Medical Care Improvement Initiative
We have partnered with Best Doctors, Inc. to develop the Best Doctors Occupational Health Institute (BDOHI). Best Doctors, Inc. www.bestdoctors.com is the world leader in connecting patients to the best medical care and was recently recognized as “changing the face of American Medicine” by CBS’ 60 Minutes. The Best Doctors’ programs help dramatically improve the quality of care by making sure patients get the right diagnosis and the right treatment the first time. BDOHI www.bdohi.org is a community of physicians and allied health professionals dedicated to improving the quality of care for employees with work-related injuries. Physicians affiliated with BDOHI have been selected by their peers as being the “best” in their clinical specialties for maintaining and improving patient productivity.
Together, A.I.M. Mutual and BDOHI help employers establish a solid working relationship with a primary occupational health professional. This is a critical first step in gaining control over the quality of care delivered to injured employees. These professionals are trained to respond to the specific needs of a work-related injury and become knowledgeable about the employee’s job responsibilities, the employer’s organization and philosophy regarding return to work and modified duty.
BDOHI Nurse Advocates work with moderately to severely injured employees from the time of injury, helping them find the right care quickly. They answer clinical questions from the injured employee and family members, seamlessly coordinating efforts with the A.I.M. Mutual claim management team.
Careful attention is also paid to the injured employee “at risk.” Studies have shown that employees with histories of smoking, obesity, depression or previous abuse are at greater risk for compromised recovery, lengthening their duration of disability. A.I.M. Mutual claim technicians identify “at risk” employees at the time of injury to minimize the impact these conditions can have on recovery and to reduce time away from work.
Pharmacy Benefit Management Program
As part of A.I.M. Mutual Insurance Companies’ workers compensation claim management services, injured workers are encouraged to use a pharmacy program through Express Scripts, Inc. (ESI). ESI is a pharmacy benefit management company that is uniquely set up to provide prescription medications for work-related injuries.
Injured employees are notified by mail about the pharmacy program and how it works shortly after their claim has been approved. To reduce out-of-pocket expenses, ESI provides a prescription identification card that is valid for prescriptions related to the specific, approved work injury. Until the card is issued, a Temporary Prescription Services ID is available in the employer Claim Kit. To maximize cost savings, employees are asked to use an Express Scripts affiliated pharmacy to fill their injury-related prescriptions. Express Scripts also offers a mail service program.
Temporary Prescription Services ID
Available in our Workers Compensation Forms Library.
Express Scripts Pharmacy Network
Click here for a list of Express Scripts affiliated pharmacies in the Northeast or call Express Scripts at 1.800.945.5951 to verify if a pharmacy is part of the network.
Stay at Work/Return to Work Program™
The objective of A.I.M. Mutual Insurance Companies’ Stay at Work / Return to Work Program™ is to eliminate or minimize the duration of disability resulting from an occupational injury. The program is uniquely designed to keep an injured employee in his or her original job, with sensible modifications. When modifications are not’t practical, we advocate assigning an injured employee to an alternate meaningful position.
We firmly believe, and studies confirm, that the sooner an injured worker returns to work in some capacity, the better the recovery and outcome. Not only does this benefit the injured worker, it dramatically impacts workers compensation costs and creates a positive culture within the employer’s workplace.
Two elements critical to the success of the Stay at Work/Return to Work Program™ are:
- Establishing the program before an injury occurs, and;
- Focusing on the injured employee’s capabilities rather than his or her disabilities.
An A.I.M. Mutual Claim Representative can customize the Stay at Work/Return to Work Program™ to meet the needs of a particular employer.