Top 10 Plays to Move Stagnant Workers’ Compensation Claims Toward Resolution

Stagnant claims are some of the most costly and time-consuming challenges in workers’ compensation management. They inflate reserves, extend indemnity exposure, complicate pharmacy and medical utilization, and create discovery and litigation tail that’s harder (and pricier) to unwind. Common stall points include unclear treatment plans, missed appointments, vague work status, delayed diagnostics, gaps in communication with providers, and misaligned expectations among stakeholders. The longer they linger, the more likely they are to become—as we’ve seen time and again—exposure multipliers.

This playbook focuses on decisive actions you can take now. Each strategy is designed to bring medical facts to the surface, tighten timelines, and align parties on realistic outcomes—so claims move from idle to actionable. Here are ten proven strategies that adjusters and claim managers can implement right away to push stagnant files through the pipeline and bring closure more efficiently.

1. Activate Communication with the Authorized Treating Physician (ATP)

Open dialogue with treating physicians. You’ll identify important medical milestones, understand treatment barriers, and reduce unnecessary delays. In states where unilateral communication is allowed, adjusters can:

• Host direct medical conferences via phone to clarify issues like expected MMI dates or work status.
• Send strategic letters to the ATP requesting clarification on treatment necessity and return-to-work timelines.
• Ask targeted questions, e.g., “Is the current pain management plan expected to extend longer than 60 days?”
• Ask whether prescribed medications have equally effective generic alternatives that could reduce pharmacy costs without compromising patient care.

Pro Tip: Aim for “definite” wording from providers. Phrases like “will likely require” can often be reframed as “is medically required,” reducing ambiguity in claim handling.

2. Closely Monitor Compliance with Medical Appointments

Missed appointments and inconsistent care prolong claims. Equip your systems to alert you when a claimant:

• Misses more than one appointment in 30 days
• Repeatedly reschedules or delays rehabilitative care
• Cancels specialty referrals

In jurisdictions where it’s permitted, consider filing a motion to compel treatment compliance—or even suspend temporary total disability (TTD) payments—to prompt progress.

3. Contact the Claimant Directly (Pro Se Only)

When a claimant is unrepresented, consider reaching out to them directly with a reasonable, documented offer.

• Explain the structure of the settlement and what will happen if they continue treatment.
• Listen for shifts in their expectations, pain levels, or life circumstances that may make them more open to resolution.
• Follow up consistently but professionally to ensure good faith communication.

4. Initiate a Settlement Offer

Don’t wait for claimant’s counsel to make the first move. Take control of the narrative by:

• Evaluating indemnity exposure and medical needs early in the claim lifecycle.
• Initiating your offer before depositions, IMEs, or statutory deadlines to influence momentum in your favor.
• Using surprise timing, which can help move cases out of gridlock.

5. Engage in Mediation—Even if It’s Not Required

Mediation isn’t just for litigated claims. It’s an incredibly effective settlement accelerator even in seemingly low-conflict or “routine” cases.

• A skilled mediator can test both sides’ expectations and reframe settlement dynamics.
• Tap mediators who specialize in workers’ compensation and understand medical, employment, and indemnity vocabulary.

6. Request New Independent Medical Evaluations (IMEs)

An updated, independent medical opinion can serve as the catalyst for settlement or claim closure. Consider scheduling an IME when:

• The treatment plan seems excessive or unclear.
• There are reported symptoms inconsistent with objective findings.
• The claimant’s recovery has plateaued.

Pair an IME with surveillance to provide additional clarity (see Play #7).

7. Conduct Surveillance Strategically

Surveillance is most effective when timed with:

• IME appointments
• Depositions
• Activities the claimant has represented as “unable” to perform

This allows you to gather evidence to confirm or refute symptom exaggeration and tailor your negotiation strategy, accordingly.

8. Assess Light Duty Accommodations with Employer Partners

Light duty jobs are one of the most under-utilized but powerful tools to reduce indemnity costs. Facilitate:

• Early conversations with the employer to identify potential roles.
• Interpretation of medical restrictions into practical job descriptions.
• Returning the claimant back to the workplace—safely and cost effectively.

9. Utilize Medical Cost Projections and MSAs

Be proactive in managing settlement readiness by predicting total future medical costs. Leverage:

• Medical cost projections for non-Medicare claimants to prevent underbudgeting.
• Medicare Set Asides (MSAs) when appropriate—plan ahead to minimize last-minute surprises.
• Vendor partners for accurate forecasting without over-reservation.

10. Leverage Relationships

Resolving claims efficiently doesn’t just depend on data—it depends on relationships. At Chartwell, we:

• Maintain trusted networks of medical professionals, mediators, specialty IME providers, and more.
• Build rapport with opposing counsel, often reducing the cost of discovery and friction in negotiations.
• Keep communication open across cases to ease settlement paths.

At the end of the day, people drive outcomes. The more trust, respect, and consistency built between claims stakeholders, the more likely both sides are to find common ground and reach resolution. Solid relationships move outcomes in your favor.

Execute the Play

If stagnant claims are driving up your reserves or clogging your pipeline, implementing just a few of these strategies can reposition your program for movement and resolution.

Want tailored support to design your claim resolution playbook? Connect with Angel Gomez, Taylor Poncz, or any member of Chartwell’s Workers’ Compensation team to explore defensible, proactive solutions built around your program.