Or, Why Every Employer Needs a Clear, Definitive Post-Injury Response Procedure
Often the question arises: “Why report so much on workers’ comp fraud? Isn’t that just highlighting other people’s bad behavior? It may seem like that, but in actuality reporting on fraud highlights the very serious cost factor, in both money and time, employers suffer from not only “other people’s bad behavior” but also, sometimes, their own. It also highlights why every company needs a tight post injury response procedure.
A recent newspaper article* gave a very detailed report of a woman who suffered a fall. The problem was, she collected $4,500 in workers’ compensation benefits before anyone questioned her story.
An investigation by the employer’s workers’ comp insurer discovered these wildly varying accounts of when, where, and how the accident happened. (WCxKitz)
1st: The woman said she fractured leg on the steps of the employer’s building.
2nd: The woman said she told her employer she caught her foot outside on a loading dock step.
3th: She left work, drove herself (using her left foot) to a friend’s, to get ice for her injury.
4rd: Medical notes (at hospital) indicated she fell at home after a fall downstairs, twisting her ankle.
5th: Another hospital note said she fell down steps indoors.
6th: She had either two alcoholic drinks, or three.
7th: A medical review by the insurer’s orthopedic surgeon showed her injury was so severe, he questioned the woman’s ability to walk on her ankle, at work, for the four-hour period she claimed – from noon, when the injury took place; until 4 p.m., when she arrived at the emergency room. Although, it’s not entirely clear if she was walking on her injured leg/ankle.
7th: She was unable to provide the name of her friend who allegedly took her to the hospital to the employers WC insurance investigator.
Whether this woman committed fraud or not is beside the point. The conclusions one might draw from this story is either the employer did not have post-injury response procedure in place or, if they did, they failed to activate it. (WCxKitz)
At minimum a post-injury response procedure, an integral part of both the workers’ compensation and safety programs, must include.
1.Post-Injury Response Procedure Guidelines
2.Post-Injury Response Procedure Worksheet
3.First Report of Injury Form.
If this woman’s employer followed a post-injury response plan, the injured worker would report to a designated person (supervisor) when the accident happened; the incident would be documented; witnesses could be secured; the injured worker would be accompanied by an employer representative to a treating facility; the attending physician would be presented with the necessary forms to fully document all aspects of the worker’s injury.
Sample Post Injury Response Plan
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Instead, the worker is arrested and accused of fraud; no one can figure out what really happened; the employer’s workers’ comp insurer is suing, the woman’s attorney is outraged, and everyone is unhappy. Make sure employee statements and photographs of the injury scene are part of your post injury procedure.
Oh, and by the way – does anyone think any of this is cost effect; will decrease the employer’s “mod” rate; discourage other workers from doing the same thing; be settled anytime soon?
