No matter the type of claim, adjusters will get a feeling right away if a claim is going to be trouble or not. The first indication is from the first phone call to the employer. If the employer has a negative feeling about the injury and details surrounding the injury, it means that this claim could potentially be trouble.
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Injury Response & Return To Work Program Need to Be Consistently Applied
Let’s face it–every employee is not a big fan of working their job day after day. Employers are not required to be huge fans of all of their employees as well. This is not a marriage, this is business. With injury claims, two negatives are not going to equal a positive.
In this scenario, the adjuster has to mitigate between the two parties. The adjuster has the control to make this claim a positive one by getting the disgruntled worker prompt medical treatment and back to light duty work as fast as possible so little is disrupted in the world of said employee.
A potential issue arises where an employer may be selective in who works in the light duty program. Not only is this a bad idea, but it is really not fair to those employees not selected to work. It is not productive, not beneficial, and it will not “punish” the employee by keeping them at home.
What it will do is create an even worse relationship between the worker and the employer. This is when the claimant will start to push the issue of the injury, by making it seem like it is worse than it is. Their efforts are to show the employer how injured they really could be if they wanted to be.
Negative Relationships Between Employer & Employee Lead to Negative Claim Outcomes
Adjusters know this type of issue is going to happen before it even starts. It is ultimately about control. The employee is trying to control the employer by malingering around and extending their claim for as long as they claim. The employer is trying to control the employee by saying they cannot come back to work until they are on full duty.
The adjuster should have the most control, and this is where they have to step in to stop all of this from even starting. The best thing an employer can do is work employees while they are recovering. The best thing an injured worker can do while recovering is to be up and around and productive, not sitting around the house irritated and becoming financially strapped as the days go by.
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Positive outcomes can arise if everyone does what they are supposed to do. Someone gets hurt, reports it, treats for it, and then is placed in the light duty program. Any failure of that flow will result in a hurdle, derailing the claim off of its tracks. The adjuster has to pilot the ship, and they have to be in a situation where both sides will do what the adjuster says.
Pushback from the employer on resisting light duty work solely because they do not like the employee is bad business. It will create a bad air in the plant, and it will make future claim relations a lot more difficult because a “pick-and-choose” situation arises.
Communication Is Key
We say time and time again that communication is key. The adjuster has to clearly communicate to both parties what their options are, and the negative results that could happen from not doing what they are supposed to do. This goes for employers as well. Workers want to know that should an injury occur they are taken care of. The last thing any employer needs is an “us-versus-them” environment. Nobody wins in that situation.
You have a light duty work program for a reason. It is there to provide productive work for injured workers that are in recovery from an injury that occurred in the course and scope of their employment. Light duty jobs must be reasonable, productive, and of benefit to the employer. We have all heard stories of the employer who has a light duty program of making an injured worker sit in a room and stare at a clock. Or a light duty job where they remove screws from a box, count them, and put back in a box. These days those jobs will never hold up in litigation, and you are only wasting your own resources by creating these negative situations.
The bottom line is to have positive injury claim outcomes, no matter who is hurt and no matter what other negative factors apply. Treat everyone the same, let your adjuster steer the ship, and do what you 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: mstack@reduceyourworkerscomp.com.
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