The Employer Role in Managing a Workers Comp Claim

1.      Pre-injury process

2.      The injury occurrence

3.      The claim process

4.      The claim settlement

1.      Provide each new hire with an employee accident brochure outlining what the employee should do in case of an accidental injury.

2.      Have a written transitional duty policy.

3.      Provide each supervisor within the company a written guide on how they are to report and be involved in workers comp claims.

4.      Post the injury procedure policy where all employees will see it.

5.      Have a published returned to work policy.

6.      Have a strong safety program and tie the manager's performance evaluation, raise, bonus or promotion to his or her safety record.

7.      Award each month (or quarter) the department with the best safety record with recognition and prizes to the employees.

8.      Have a medical provider network in place through your insurance company or join a medical provider network for self-insureds.

9.      Prevent fraud by letting all employees know workers comp fraud takes money away from their raises and bonuses.

 10.  Put up posters reminding employee that workers comp fraud is a crime and will be fully prosecuted.

11.  Post all the state required notices in a place convenient for all employees to see including workers comp laws, OSHA posters and anything else required in your state.

12  .Post a list of the required medical providers (where allowed by state statute) or recommended medical facilities (in the states where the employee is allowed to select their own doctor).

II. The Injury Occurrence

Even companies with the strongest safety programs will have some workers comp claims. When an injury occurs, the immediate actions taken by the employee's supervisor or co-workers have an impact on the outcome of the claim. The employer must require a tight injury process, including:

1.      Obtain immediate medical assistance for the employee – send the employee to designated doctor or medical facility if statute permits

2.      Do not permit employee's with minor injuries or soft-tissue strains to wait to obtain medical assistance – most will end up going to the unapproved hospital emergency room or their own doctor

3.      While the employee is in-route to the treating physician, advise the treating physician of any temporary jobs you can offer during recovery (WCxKit)

4.      Advise the treating physician of modifications you can make to the existing job to accommodate the any work restrictions the physician gives the employee

5.      Have a goal of returning to work all employees within 1 to 3 days after the injury unless they are medically unable to perform any role for the employer 

 III. The Claim Process

1.      Report the claim to the insurer, third party administrator or self-insured claims office immediately. The supervisor or your workers comp claims coordinator should be reporting the claim to the claims office while the employee is still enroute to the medical provider.  

2.      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 will be unable to return to work within the waiting period, provide the claims office with necessary wage information for the calculation of indemnity benefits.

3.      Advise the claims office of the claimant's prior history of workers comp claims. The adjuster's approach to the claim varies significantly between the employee who never had a prior workers comp claim and the employee who has had 15 workers comp claims in the last ten years.

4.      Review your transitional duty program and find a job the employee can do within the treating physicians restrictions.

5.      Be sure the employee's supervisor (and co-workers if needed) are available to discuss the accident and injury with the claims adjuster and to assist the adjuster with the claims investigation as needed.

6.      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 will get ugly when employees feel it is time to stick it to the employer.

7.      Maintain an open dialogue – call the employee at home to show your concern and to offer assistance on processing the workers comp 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.

8.      If you are contacted by an attorney representing the employee, notify the claims adjuster immediately.

9.      Immediately dispute any invalid or fraudulent claim.

10. If the employee has a questionable claim, or a subjective claim for neck or back injuries, and immediately goes to the television advertising workers comp attorney, or a plaintiff's attorney-oriented doctor known for excessive disability ratings, advise the employee immediately that you intend to fight the claim as the attorney and/or doctor has a history of inflated claims

11. Monitor the state filings by the adjuster and any other claim related paperwork

12. 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.

13. 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.

14. Always advise the adjuster when the employee returns to work – the same day.

1.      Attending depositions and hearings.

2.      Attending the settlement conference (with settlement authority if you are self-insured).

3.      Working with the vocational rehabilitation specialist to accommodate the employee's return to work if there are any ADA concerns.

4.      Providing rehabilitation training if necessary.

1.      Going without workers compensation insurance. This is a criminal offense in most states, you will pay fines, you will pay the claim out of company funds and you could end up paying your own cost to defend a lawsuit from the injured employee.

2.      You cannot terminate the employee for filing a workers comp claim.

3.      You cannot refuse to hire an employee solely because of prior workers comp claim history (unless the prior injury(s) makes it impossible for the employee to do the job under consideration).

4.      You cannot charge an employee with any part of the workers comp premium.

5.      You cannot pay the small claims out of company funds and not report them to the workers comp insurer.(WCxKit)

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

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