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communication is important. However, it’s often just as important, to know who NOT to
communicate with.

During our CHAMP certification training course, we spend a lot of time discussing the importance

of knowing and understanding the roles and relationships that control a workers’ compensation
claim assignment. For someone that doesn’t spend a lot of time in the workers’ compensation
industry, it can be a bit confusing and overwhelming. In order to keep it as simple as possible, we

suggest that the provider always know the answer to one simple question; “Who has the authority
to authorize?” Ultimately, on any file, there is a person that has the ultimate authority to authorize

a product or service. Unless otherwise instructed, that person becomes the initial recipient of all
communication and documentation. That person can then share the information to the appropriate
parties, or they can provide instruction to the provider as to who should be copied on

communication. That person should also provide instruction to the provider as to how they prefer
to be communicated with, and how often. If you are a provider, ask who has the authority to
authorize. If you are a carrier, help the provider by making it clear who the point person is that

they should be communicating with.

When it comes to when and how to communicate, like most things in workers’ comp, the answer
is “it depends”. While there is no definitive standard established, the following is part of the best
practice policy we teach and a pretty good place to start. I believe the best results are achieved

by a collaborative process of experts with specialized skills, all working toward a common
outcome objective.

Home modification projects are completed by a three-phase process. Phase one is the home
assessment that should lead to an agreed scope of work. The second phase is obtaining a

reasonable cost for the agreed scope of work. And the third phase is the completion of the
construction of the modifications.

For phase one, documentation should include a detailed home assessment report that justifies
the recommended modifications based on medical necessity. The assessment is the key

document that supports the authorization and denial of modifications. While the written report is
a key document, there are many other conversations that take place before the final scope is

agreed upon. Those conversations should be documented and stored for future reference.

Phase two is the development of the reasonable price for the agreed scope of work. The key

document during this phase is the contractor’s estimate. How the estimate is submitted depends

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