Workers’ Comp Claims Handling: The GUARD Difference
We have long prided ourselves on fast, fair, and effective claims handling. Our toll-free hotline and online reporting – available 24/7 – enable us to react quickly to minor incidents while channeling more complex cases to one of our specialized units.
Specialized Claims Units
Not every Workers’ Compensation claim requires the same level of involvement. That’s why our model uses a structured triage approach to evaluate injury characteristics, medical needs, the potential for time away from work, and overall complexity. Specialists from our various units are then assigned to each case.
Designed for injuries involving limited medical treatment and minimal disruption to work activities.
Focused on lost-time injuries and situations requiring proactive coordination, return-to-work planning, and increased engagement.
Managed by experienced specialists for litigated, catastrophic, fatality, or other highly complex claims.
The Importance of Immediate Claims Reporting
The initial days following a workplace injury/illness are among the most critical. In fact, the first 24 to 48 hours after an injury often shape the entire claim experience and eventual outcome. Early engagement helps us establish immediate communication, coordinate appropriate medical care, and identify possible return-to-work opportunities (in line with physician recommendations). Only the administration of emergency medical care should come first.
Lauren Jason - Medical Only & Early Intervention Claims Director
”Those 24 hours after a workplace injury occurs are critical. 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.”
Medical Management
For claims that involve medical treatment, our in-house licensed and accredited medical management* team works alongside our adjusters to help coordinate care. Overall, we strive to facilitate a quality treatment plan in a cost-effective manner with the goal of returning the injured party to normalcy in line with physician recommendations.
*Managed medical care is voluntary in some states. Services vary by state and are offered in conjunction with all state laws and regulations.
Services include:
• Utilization review and nurse case management
• Use of occupational health provider networks
• Prescription drug oversight
• Medical bill review/hospital audits
• Vocational rehab plan
• Ongoing treatment evaluation
• Clinical support and consultation
Jason Volonakis - Complex Claims Director
”Procedurally, our intake process begins when the claim is reported to us. 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.”
Return-to-Work Strategies
Getting an employee back to work as soon as possible after an incident is beneficial to all parties. The healing process can be quicker for the employee, and the employer can avoid further disruptions in workplace productivity.
Successful return-to-work programs focus on capabilities, not limitations. When employers think beyond an employee's original job duties and identify modified or transitional work opportunities, injured workers can maintain routine, stay engaged with the workplace, and continue progressing toward recovery.
Learn more about the GUARD’s Return-to-Work Program.
Lisa Krzywicki - Nurse Case Management Manager
“It’s all about regular communication between the nurse and the injured worker. We strive to get employees the appropriate treatment from the start, identify potential issues early, and address obstacles before they become barriers to recovery. We work proactively to keep injured workers engaged in their care, helping drive better recovery and return-to-work outcomes."
Complex Cases
Some claims require additional expertise. For cases involving litigation, catastrophic loss, fatalities, significant medical complexity, or extended disability exposure, GUARD's Complex Claims professionals provide specialized oversight and coordination.
These teams collaborate with nurses, legal resources, and other subject matter experts to develop strategies tailored to each claim's unique circumstances. This multidisciplinary approach helps ensure that even the most challenging claims receive focused attention and experienced guidance.
