Reporting Work Injuries To Your Carrier – Golden Rule

The Golden Rule For Reporting Work Injuries Keeps It Simple

Employers not having a rule for reporting work Injuries to the workers’ compensation carrier has caused many employers to end up paying very large claims on what should have been small ones.  

The Golden Rule for reporting workplace injuries is at the end of this article.

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The decision to write this article was made after I happened upon a popular agent’s website that had these three pieces of advice to lower a company’s workers comp costs.   The words from that article were changed not to violate the copyright and not to point out the exact-reference article. 

• Train your supervisory employees for reporting working injuries to the carrier (this statement was OK by me). 
• On-site first aid may be all that is required and not report the incident to the workers’ comp carrier (OK by me except for claims festering).
• A simple doctor’s office visit may be all that is needed, but no need to report to the carrier – Red Flag Alarm

I am consulting on a few massive claims presently where the carrier was not advised of a claim until weeks or months later.  The claims fill almost 6 – 10 brown folders of information each.   

One of the hallmarks of the claims – the initial lost time adjuster received the dreaded twilight zone phone call from a medical provider after the injury ended up being much more serious than 

The claims should have been (mostly) small claims where all the pieces of the puzzle were in place to have the injured employee treated properly medically and returned to work timely.   

Claims reporting can be equated with the old Fram Oil filter line – “You can pay me now or pay me later.”    

The Six Keys (Secrets) To Saving on Workers Compensation Claims which I wrote in the 1980s has as its #1 Key – Timely First Reports of Injury. The dominoes start to fall if the claim is not reported timely.   The other keys cannot be attained if the Workers’ Comp claims staff receives a stale FROI. The adjuster has no choice but to put up very large reserves on the file.  

The usual results total an approximately 400% increase to those claims.   How do I know?   I tracked over 7,000 public entity files in the 1990s.  As the Director of Risk Management,  I recorded on a spreadsheet the claims that reached my level of authority.  Almost all had the same four characteristics in one form or another.   

I then tracked the same results when I was assigned claims as a consultant.   The claims almost always had the same characteristics.  The only other characteristic from the claims staff side was the adjuster did not make three-point contact and investigate the claim timely even f the FROI was filed timely. 

A Workers; Compensation claim’s loss control ends 48 hours after the claim.  The treating Doctor is in place.  Controlling the medical remains the best method for controlling Worker Comp payouts and reserving on a claim. 

The Golden Rule For Employers Reporting Work Injuries is: 

If an injured employee has to leave the employer ‘s premises or stops work except to receive First Aid, the claim should be reported immediately to the carrier or TPA (Self-Insureds).   

The rule applies even if the employee just leaves for the rest of the day and is expected back the next workday.   The 48-hour clock starts ticking when the employee stops work.   

Please note this is a general rule – certain injuries such as burns or chemical exposures need to be reported even if the employee stays at work.  Consult your state’s rules on these specific situations.   This article does not apply to recording OSHA recordable incidents.   Your carrier or TPA may have certain reporting requirements.

The advent of online claims reporting speeds up the reporting work injuries timeclock greatly. 

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.

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