Adjusters are very particular on wording, especially when it describes an injury or event. Below I am going to use some real-world examples of injury descriptions from real work comp claims. Don’t laugh, you may be the one reporting injuries this way. If you are, hopefully you will find some helpful tips to be more expressive going forward:
Example #1: “Injured Back Lifting Boxes”
For example, an adjuster reads the injury report on a new claim and the description reads “Injured back lifting boxes.” That entire statement says nothing in the mind of an adjuster, other than the back is the area injured.
Supervisors often provide little information
The employer is often contacted first, and this is sometimes a mixed bag of results. They confirm a back injury, but another supervisor was there and that person knows more about it, they just heard through the grapevine that so and so got hurt last night and are not back at work today. That is the extent of what the supervisor knows, and the other contact person was not at that location and has no idea what is going on.
First of all, that phone call was a waste of time for both people. Not only did the adjuster get zero information from the employer, but now the adjuster has to talk with the claimant without any prep information, and no information on the accident details.
Then when the adjuster calls the injured worker, the injured worker states that he/she was injured when they “Lifted a 65lb box and felt a pop in their back which radiated down the legs causing them to drop the box and EMS was called to take to hospital due to severe pain.”
The employee always does the best job of describing an injury. Leave it to them to tell the adjuster every detail. And they should, because they are hurt and they want everyone to know what hurts and how they were hurt, and they want treatment for everything that hurts.
This entire scenario is how a loss control protocol should not work. Every claims person out there loves that an employer has a loss protocol set up, and they follow it to the T. But, what information are they actually providing the adjuster?
Injury response procedure goal should be to provide adjuster with as much detail as possible
The claims person is the one that needs as much information as possible, before they talk to the claimant within a 24-hr period post-notification of the claim. But if the employer can’t help the adjuster with any information, what good is having protocol to begin with? Sure, you reported the claim timely, but it is void of any real information that is helpful.
I understand that there are technical limitations. Most injury forms only give you a little area to type in what happened, but be creative and descriptive. That is what will help the adjuster.
Better yet, if you are not using Injury Triage, you should be. The triage nurse will get the details of the injury, assess its severity, and recommend the property treatment.
Example #2 on a hernia claim: “Worker lifted boxes all day and has hernia.”
What kind of boxes and how much did they weigh? Were they lifting one box and had a specific incident that was diagnosed a hernia, or did this person come in and say they have a hernia? How long is “all day?” This entire injury statement says nothing other than a hernia. A great way to correct that statement is “lifted a 45lb box/felt pain/clinic diagnosis hernia.” Now in that statement, you know the worker was lifting a box, it weighed 45lbs, and that they must have went to the clinic right away because a hernia was already diagnosed by the clinic doctor. That is good information to know! Now the adjuster knows more about the injury, the diagnosis from the clinic doctor, and that it appears to be a specific isolated incident.
Example #3 “While unpacking parts she felt a boom in her back.”
I am far from a physician, but that is the first time I have heard of a boom in relation to an injury. So she felt a boom. What is a boom? Is that burning pain? Shooting pain? A strain? Where was the boom, in her low back or upper back?
Other descriptive words do a better job. Words like “sharp” or “shooting” or “burning” pain help adjusters with the type of pain this worker had at the time of injury. A way to correct that statement is to label the pain differently, using the examples above. Also always be sure to include the injured area as specific as possible. Descriptions such as “While unpacking 2lb parts she felt a sharp pain in right low back.” Now you have given the adjuster something to work with. We know the part weight, the type of pain, and the location of the pain.
Challenge Yourself To Provide Specific Information
The reason why all of this is important is because of when the adjuster takes the statement from the employee. Using example 3, the worker may say she had pain all over her back, or she may say she had pain in a different location, or she may say the parts were 25lbs each and not 2lbs in order to make her claim sounds more convincing.
So think about your injury statements. Be as descriptive as possible while providing as much information as you can. We all know there are only so many words you can put in that description, so challenge yourself to address weight, injury locations, pain types, and anything else you can fit in there.
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. http://reduceyourworkerscomp.com/about/. Contact: [email protected].
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