As crazy as it sounds, a lot of people do not know if they are hurt. Here is the scenario: A worker tweaks their back during some sort of work activity and they do not tell anyone that day. The next day they mention something to their supervisor about flaring up their back pain. The supervisor asks if they are ok and they answer “I don’t know.”
This happens all of the time. It is always surprising as to how a person doesn’t know if they are hurt or not. It should be simple. You are either hurt or you are not, right?
Many Minor Claims Can Be Avoided With Early Medical Treatment
Of course this is wrong. If every worker in the plant made a claim when they experienced some sort of pain you would have 9,000,000 claims each month. You trust that if the worker is really hurt, that they will tell you and want to report a claim. However, much of the time, they are not sure, and do not know what to do. So they tell their supervisor, expecting to get some sort of guidance. But the guidance doesn’t come from said supervisor.
This is a great opportunity that is missed. I tell employers if this situation happens, get the employee medical treatment by calling a 24 hour injury triage nurse (or send to a clinic if triage is not set up). It is better to be safe than sorry. But most employers are stubborn in this regard, and instead of getting them medical attention they say “Well let me know if you are hurt and we can address it at that point.”
What happens is the worker doesn’t go back to said supervisor. Because in their mind, they did go to the supervisor and told them they are hurt, and it got them nowhere. Now they work through the pain until they make it so bad they can no longer work at all. Then they want to report a claim and want to go get medical treatment. The only problem is now it is a month later.
When the adjuster gets this claim, they see the injury date as being a month ago and all sorts of red flags go up. Why wasn’t this person sent to the clinic a month ago? What happened between a month ago and now that they want to go get treatment? Why was this not reported a month ago like it should have been?
The answer is simple: The employer doesn’t want to get dinged for another possible injury on their loss run (many claims are avoided by using Injury Triage). It makes them look bad, and they worry about increased premiums and underwriting and OSHA recordings and so on.
This problem is all over the place in work comp like an epidemic. I tell employers all the time if someone comes to you and says they might be hurt, you should get them medical attention (ideally with Injury Triage) right away, because a simple back strain if caught early is super cheap to get rid of. If you wait until a month later and the guy can barely stand up straight, this is going to be a claim that is around for at least a few months, if not longer. Plus the cost is probably 4 times more now than had you sent the worker for treatment a month ago. You are shooting yourself in the foot by waiting.
If Someone Says They Might Be Hurt, They Probably Are Hurt
Just the mere fact that the person said they think they might be hurt is enough to seal the deal that they are probably indeed hurt. Employers should not be afraid to report an injury, particularly to an injury triage nurse. A call to a triage nurse does not trigger a claim, it merely gets the employee evaluated by a medical professional that will give a recommendation for home care, or further evaluation by a medical professional.
Sadly, this is the environment we are in. Fear of increased costs hang around the employer, like a monster under the bed of a 6-year-old. They know it is there, but just want to ignore it and hope it goes away. But this is not make-believe; this injury will rear its ugly head again in the near future, so there is no point in trying to sweep it under the rug.
Both Employees & Employers Need to Be Educated on Injury Reporting
The responsibility doesn’t sit only with the employer in this situation. The employee also has to know if they are hurt or not. Employees are in the same fear boat: They do not want to get in trouble, they do not want to deal with work comp, and they do not want to be hurt. So they hope it will go away. Chances are it will not. In the end they get punished by this delay in treatment and reporting. The adjuster says “Hey anything could have happened in this last month, so why should I pick up the tab when we are not sure what exactly happened?” And they are right. Injuries that are reported promptly with immediate medical treatment are going to be picked up more often than those with delays in reporting and medical treatment. So due to a lack of reporting and treatment, they deny the claim most the time. Denied claims such as these lead to a lot of litigation, because the employee knows they hurt themselves at work, and the carrier is just not so sure due to the delay. They feel they are better off denying it and seeing what happens.
All of this can be avoided. The way it has to work is two-fold: (1) the employee has a duty to report an injury to a supervisor and (2) the employer has a duty to get the injured worker medical treatment and report the information to the carrier. If everyone would just follow these rules then they will have a more streamlined work comp program where everyone is responsible and doing what they are supposed to do.
Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: [email protected].
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