Dealing with injured workers can create many challenges for claims professionals and defense attorneys. These difficulties arise from a number of factors and are a reality of the adversarial workers’ compensation system. It is important to remember this issue when dealing with claimants. The following are some tips that can help your practice handle claims in an effective manner.
Remember the Golden Rule: Treat others the way you want to be treated!
Put yourself in the shoes of an injured party for a minute. They are experiencing not only physical pain, but there is a psychological component to the injury that is often not addressed during a claim. When someone becomes injured, that person will likely have a decreased functional ability. They are also dealing with loss of wages and possibility unpaid medical bills. Treating that person how you want to be treated can pay dividends in the end, including when you are trying to settle the claim if a dispute arises.
Be a professional at all times—especially when the party is not represented by an attorney.
Like it or not, attorneys sometimes create more problems in the long term when they represent an injured party. Numerous studies indicate that injured workers seek an attorney when they feel they are not being dealt with in an honest and professional manner. While you have an ethical obligation to your employer and client, treating the injured worker professionally can be the first step resolving a claim.
Treat the injured person with dignity—especially during the course of litigation
It is important for attorneys to be mindful of how they come across to applicants during the course of litigation. If an attorney represents the injured party, you should never talk to the claimant outside the presence of their attorney. In instances where you are taking their deposition or recorded statement, be aware of the old saying: You can catch more flies with honey than with vinegar. Always be respectful and stay calm, especially if the worker becomes combative. If they happen to get upset, maintain your professionalism, and do not “fight” with them.
Always be ethical during the course of a claim
Claim handlers should understand applicable company policies on how they are to deal with claimants. They should also be aware of how to deal with them if they are represented and what matters are not to be discussed if their attorney is not present. In the same regard, attorneys should also be mindful of rules governing their professional conduct. This is especially important in how to deal with unrepresented claimants, witnesses and other third-persons.
Avoid Unfair Claims Practices
When working for or representing an insurance carrier, it is important to remember that you are also bound by the applicable state law governing claims practices. Failure to comply with recognized standards can result in a bad faith action being brought against the carrier. Some unfair claims practices include:
- Failure to thoroughly investigate;
- Exploiting the financial vulnerability of the policyholder;
- Making unreasonable demands on the policyholder during claims;
- Claims “extortion” – g. – accusing the policyholder, without reasonable basis, of wrongdoing; and
- Spoliation of evidence
Remember that participating and promoting unfair claims practices at a minimum can result in judicial sanctions, additional litigation and admissions against your interests.
The modern claims environment creates a tension that sometimes makes it difficult to resolve workers’ compensation claims in a timely manner. Claims handlers and attorneys can be proactive in their approach when dealing with claimants to resolve these matters by following best practices in an ethical manner.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a 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 the founder & lead trainer of Amaxx Workers’ Comp Training Center , which offers the Certified Master of Workers’ Compensation national designation.
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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.