Discovering Issues Such as Substance Abuse Requires Balancing Privacy Issues and Employer Responsibility

Discovering Issues Invalidating Workers' Comp Claims Such as Substance Abuse and Failure to Comply with Safety Requirements Is Balancing Act

Taking a proactive stance in monitoring all workers' comp claims helps you not only reduce your insurance expenses, but also helps alert you to employee issues and behavior possibly costing you money and putting other employees at risk.

In most work environments your area managers, supervisors, and team leaders know their employees well and how they perform at work and, sometimes, they even know a bit about their personal lives outside of work. This information can prove to be invaluable in situations where injury claims could be non-compensable due to mitigating circumstances such as substance abuse, an undisclosed preexisting condition at the time of employment, injury from failure to use protective equipment, or not following proper safety procedures.

Some people may say using knowledge of an employee’s personal life habits or confidential reports of inappropriate activities while at work invade the employee’s privacy. While using this information to engage in gossip would be less than ethical, information exposing work habits or activities that not only endangers the employee, but also places other employees in danger or harm is information that can save lives. On the other hand, information ignored could open the company to legal problems for negligence if they ignored relevant information.

If company safety is a top priority then when an employee is injured because of failure to follow safety procedures or was drunk on the job, it is bad for the company and everyone around the worker. There are resources to help employees struggling with addictions, whether it is substance abuse treatment, or disciplinary action for safety violations followed up with training. To let these situations continue is inviting trouble. Many

If, as an employer, it is discovered an employee falsified a claim, immediately document the incident and inform your insurance adjuster. Few people realize how fraud substantially hurts a company; especially true in the event of a fraudulent claim being reopened, but based on an undisclosed previous condition — the result of a routine task or spontaneous occurrence.

Another valuable tool is diligent and detailed record keeping of every employees conduct and accident/injury claims. You may be able to spot a fraudulent claim by examining employee records and medical histories that disclose repeated or similar behavior. (workersxzcompxzkit)

Preventable comp claims, and those from violation of safety standards, take a serious toll on company finances. Serious accidents or injuries involving multiple workers, the result of employee negligence or violation of safety standards, or while under the influence of drugs or alcohol, can substantially hurt a company or even put it out of business. In some companies, workers comp is the second highest expense after payroll, so increasing those costs or failing to control them can have serious financial implications for a company.

Note: Each state has different laws affecting the above issues, it is importnat to discuss the issues with your legal counsel before making any changes to your program.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: [email protected] or 860-553-6604.

Podcast/Webcast: Claim Handling Strategies
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.