It is always an interesting issue when talking to injured workers that have late-reported claims – very late reporting is the beginning of NOT reporting. Similar to turning in homework late while in elementary school, the list of excuses can be lengthy. The usual response is “I did tell my supervisor three times who must have just ignored me.” Then of course when talking to the supervisor, it is learned the worker never told them about any type of injury at all.
So these claims can spiral into a “he said-she said” argument where the blame will shift back and forth. The burden of proof is on the claimant to prove a work injury was sustained while completing a work-related task. And as we discussed before most of the claims that come about are legitimate in nature. [WCx]
Delays in reporting injuries can greatly affect whether or not this worker will receive benefits or not, even if said injury is to be legit and compensable. But with every day that ticks by, the story will hold less merit. Even great workers sometimes are not going to run to you after an injury. So here are some common responses as to why an injury is reported late.
1. The injured worker is a new employee
Nobody likes to be the new person on the job. It is like starting at a new school. The new worker knows no one and does not know where to go. The worker may feel the need to have to prove skills right off the bat. But even worse than being the “new guy,” is being the “new guy that injured himself on the first week of work.”
With the economy low, people are waiting longer periods of time between jobs. This leads to general deconditioning, since workers are no longer working but rather living sometimes sedentary lifestyles. It is very common to see recent new hires injured very quickly, as a result of this deconditioning. The new worker wants to grab the ball and run with it just like they have not missed a step. And that is possible, but it can also lead to injury. General deconditioning is the physical factor, but the psychological factor is far greater. And , the worker may not to admit that anything is wrong. The worker may have been unemployed for several months and has a family depending on the worker’s income or possibly bill collectors. Due to these factors, the worker will not jeopardize the job or easily admit that an injury has happened.
2. The injured worker is a veteran employee with a good track record
On the opposite side of the table is the veteran worker. The veteran has worked here for 25+ years and never had an incident. It is a great source of pride to the veteran worker. The worker has great job skills, and a good work ethic. So they may have some aches and pains, but these resolve with time. The worker has no history of a comp claim, and does not go to the doctor unless absolutely necessary. So, these workers have the opposite versus our new workers listed above, but mainly stubbornness is the factor for not reporting an injury. These claims will be reported a day or two before the veteran worker is heading in for surgery. These workers will be the first to say they never had any incidents at work before this one, so there is no question that this is work related. They feel as if they are entitled to workers comp, and sometimes can be difficult to deal with. But the adjuster will complete an investigation, and if it is compensable, then the claim will be paid.
3. A supervisor dropped the ball
Maybe the worker tells the supervisor he is hurt, and wants to report a claim. The supervisor tells the worker he should tell HR so they can get a claim called in. Then the supervisor went to lunch and forgot about it. If the process for reporting claims is not very streamlined, this is a scenario an employer will see quite often. Time is the biggest factor in any claim, and the more time that goes by before the adjuster can get control of the file, the worse the outcome on the claim could be. So make sure the supervisors know the importance of reporting the claim, if one of the workers claims an injury. And make sure to have some sort of discipline in place for those supervisors that fail to report a claim to the appropriate people within a timely fashion.
4. The injured worker had a bad experience on a prior comp claim
Some workers carry around a lot of baggage with them, from employer to employer. This means if the worker has past workers comp claims, they have dealt with multiple carrier/TPA companies, and different adjusters, all with different styles and different ways of doing things. The worker may have had very bad experiences with these adjusters, and this has soured them on the whole compensation experience. The worker says “I would rather go through my own insurance then have to go through that again.” This will not help the employee in the end, because insurance will deny it. And the worker will have to go through comp whether they like it or not creating more problems. But a lot of workers have this bad prior experience, and they do not trust the comp system, not the carrier/TPA, and will do whatever they can to avoid having to turn a claim in for an injury.
5. The worker thinks delaying reporting the claim will make it seem more legit
Some people think that waiting a few months to report a claim will make it appear they have a great work ethic, that they hoped not to have a claim to report. The worker will tell his boss “I was trying to save you some money; I did not want to report a claim. I feel bad you have to call a claim in now.” But this may not be 100% true. Some people think that injury duration is a substitution for compensability. But even if claiming to have the same shoulder problem for 2 years, it will not make a claim any more compensable than having the injury for 2 days. Age is not a factor in the overall compensability of a claim. Many other outside factors have to be taken into account, not just age of injury. (WCxKit)
We listed 5 factors in why an employee would avoid reporting a claim. There are probably dozens more, but these 5 are generalizations of what we see a lot in workers comp. It again comes down to communication, so all parties know what their responsibilities are. The HR person, the supervisor, the worker, everyone has a job to do when an injury occurs, and the compensability of the claim can only be determined by the adjuster. So if any of your workers try to pull any of the 5 items listed above, it doesn’t mean that their claim is not compensable and cam be denied. Leave that work up to your adjuster.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20%-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
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