Once an injury happens many times the employer will abandon the investigation to the insurance carrier and adjuster. Maybe they feel as if their input doesn’t matter. This should not be the case, as I have witnessed many a claim spun around due to differing information gathered by the employer.
The employer has access to many items the claims adjuster will not have access to. After all, the other workers at this facility see this injured worker day in and day out, before they were hurt from work allegedly. They could be casual friends with the injured party. If not friends, they are at least around to hear something out of the rumor mill that could help with the investigation of the claim. What could seem like a minor detail to another worker could be the major breakthrough that the claims adjuster needed. Below we mention a few things the employer can keep in mind when investigating the claim on their end:
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“The 6-Step Process To Determine Workers’ Comp Injury Causation”
Pay attention to dates and to body parts
The first thing the adjuster needs to know is what body part was injured, and when. Even more important is when the injury is a repetitive motion type of claim from occupational exposure. If a worker states their shoulder became bothersome 2 months ago, did they tell anyone? Why not? Did the pain stay in the same area, or did it reticulate down the arm? Were they able to do their same job during this time? If so, no supervisor noted any issues or failed to see any type of pain behavior? Were production numbers the same? Did any facet of the job change at all that could have led to the injury happening? Why or why not?
These are just a few examples of questions that should be asked. It is almost as if every answer the worker could have to each question could be answered with a “why?” How could they not mention anything to anyone? How were they able to keep pace when they alleged getting injured a month ago? Why would they not want treatment? All of the answers to these questions play a role in the adjuster investigation as well, because the adjuster will ask most if not all of the same questions. Then you can compare answers, and see if it all matches up.
Can you videotape the job being completed? If so, take a video
There is no better evidence to show a doctor about how an injury came about than showing them the video of the actual job. If you fail to have a video of some sort, then the doctor will take the word of the description given by the injured worker. This may or may not be accurate, and that accuracy can affect the exposure on the claim. If the job is not near as hand intensive as the worker explains, then that can affect the causal relation.
What are other workers saying about the injury and the worker?
Rumors are always going to be an issue at work, especially with a non-traumatic injury. Most of the time other workers are not going to throw their coworker under the bus without good reason. This does not mean that every little thing they say is going to be true, but it could possibly be true. That alone warrants an investigation, an ISO sweep, surveillance, and the like. Personally, I would rather be too thorough. So as employers, listen to what others are saying and ask around a little. I have seen countless claims turned around because of 2nd jobs, house-flipping hobbies, businesses ran out of garages, and so on. More than plenty of those denials began with listening to the rumor mill.
It is also good advice to keep in mind that it is always those employees who seem to fly under the radar. These are the people you would never think as pulling the rug over your eyes. Those are the claims that can be the most damaging, and the most expensive.
Trust, But Verify
Always question everything from everyone, all of the time. It is not that you don’t believe them to some aspect; it is because that is your job. This is your company’s money on the line, and this is why you are a supervisor or why you are in claims to begin with. Like I have said in the past, in the world of injury claims, we trust but verify.
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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