The employer needs to have an established post injury process to include:
- Report the claim to the insurer, third party administrator or self-insured claims office immediately. Ideally the supervisor or your workers compensation claims coordinator reports the claim to the claims office while the employee is still en-route to the medical provider. Or, you can start the process by calling nurse triage, a great way to make sure the employee gets the RIGHT kind of medical treatment. In some cases, the injury will not turn into a claim by using nurse triage.
- Complete the Employer’s First Report of Injury and any other state required paperwork on the claim. If the injury is severe and the employee is unable to return to work within the waiting period, provide the claims office with necessary wage information for the calculation of indemnity benefits.
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- Advise the claims office of the claimant’s prior history of workers compensation claims. The adjuster’s approach to the claim varies significantly between the employee who never had a workers compensation claim and the employee who with 15 workers compensation claims in the last ten years.
- Provide the adjuster with relevant information about the employee. In many situations this may include employee information such as employment application, job description, list of medical absences, list of disputes with employee/employer disputes.
- Review your transitional duty program and find a job the employee can do within the treating physician’s restrictions. Have a job bank with tasks in multiple departments set up and ready to go, so there is no delay in placing every injured employee in a transitional duty task. In most states, it is best to pay as close to their original pay as possible to reduce indemnity payments.
- Be sure the employee’s supervisor (and co-workers if needed) is available to discuss the accident and injury with the claims adjuster and to assist the adjuster with the claims investigation.
- Don’t alienate the employee – show empathy to the employee. When employees feel the company does not care about them and their injury and the company owes them, the claim gets ugly if employees feel it is time to stick it to the employer.
- Maintain an open dialogue – call the employee at home to show your concern and to offer assistance on processing the workers compensation claim with the insurance company. Address any employee problems or issues right away. Also, call the employee on a regular basis until s/he is back at work. Make this contact procedure the same for all employees.
- If an attorney representing the employee contacts you, notify the claims adjuster immediately.
- Immediately dispute any invalid or fraudulent claim. Assume every employee who reports an injury is injured, but when you notice things don’t add up, let your adjuster know. Using nurse triage services greatly reduces fake injury reporting because a nurse specialized in triage will ask many questions about the medical condition, and most employees faking an injury will look for easier prey.
- If the employee has a questionable claim, or a subjective claim for neck or back injuries, and immediately goes to the attorney advertising workers compensation on television, or a plaintiff’s attorney-oriented doctor known for excessive disability ratings, advise the employee immediately of your intention to fight the claim as the attorney and/or doctor has a history of inflated claims.
- Monitor the state filings by the adjuster and any other claim related paperwork.
- Monitor the Workers’ Compensation Board decisions – that means, reading them carefully, not just filing them away. Be ready to protest any finding or order you feel is unfair to you as the employer as all decisions have time limits for disputing the decision, with some time limits as short as 15 days.
- Monitor the medical progress reports to be sure the treatment is appropriate – for example – no physical therapy for the low back when the injury is a cut finger.
- Always advise the adjuster when the employee returns to work – the same day. Double-check to make sure the indemnity payments stop when the employee returns to work.
Stay involved with the adjuster, the employee and the medical providers. As long as it’s an open claim, it can affect your experience rating, so dropping the claim on the adjuster’s desk is the WORST thing an employer can do. Ask your broker’s claim VP and the adjusters to discuss the open claims during a round-table discussion often, either weekly, bi-weekly, or monthly.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .
Contact: [email protected].
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.
