Workers’ compensation claims are potentially part of every business, whether your client (or yourself as a self-insured company) only employs workers sitting all day at desks, construction workers, medical staff, agricultural workers, a fleet of drivers or more. Wherever there are people working, there’s the potential for a work injury - and a risk of accidentally creating one or more workers' compensation claim mistakes. That’s why your clients need you not only to insure them, but to provide best practices.
Regardless of your client’s particular risk for work injuries, it pays to know what the top risks are, and how they can avoid them. Forewarned is forearmed, they say, so share these top mistakes (and how to avoid them) with your insureds.
They already know to ensure they’re hiring employees properly qualified for the job. They’re training new hires how to safely perform job duties. And they’re continuing regular (and documented) safety training for all employees, focusing on proper use of equipment and how to identify and handle potential hazards.
However, in spite of their best efforts, an employee has been injured and they’re faced with a claim. Here are the top seven workers’ compensation claim mistakes seen most frequently, along with how they can avoid them:
1. Waiting to report the workers' compensation claim
Not reporting a claim right away is a bad idea that will cost money in the long run. Our studies show that when a worker’s compensation claim was reported more than 10 days after the event, costs rose by 60 percent on indemnity claims, and by 64 percent on medical claims. Even if the incident appears to be minor, it’s still best to report it in “report-only” mode, which alerts us to the accident without turning it into a formal claim. This actually protects your client if and when it does become a more serious claim.
Filing right away does two things: it allows the investigation to begin immediately, while details are still fresh in everyone’s minds, and it also assures the injured worker receives the proper care and attention so that they can recover more quickly – again, saving your client money.
2. Failing to investigate immediately
“The best investigator on a workers’ compensation claim is the injured worker’s immediate supervisor,” said James Ryan, senior vice president of field claims at SRS. Why? Because the supervisor understands the job role and duties and has valuable insight into where the injury occurred, and if there were any extracurricular activities that might impact the claim. The supervisor also knows the claimant and coworkers, and can quickly gather eyewitness reports. These details are crucial to the adjuster who will be investigating the claim, and will help to minimize any workers’ benefits claim mistakes.
3. Not sufficiently documenting the accident details
Asking all the right questions – the who, what, when, where, how, why, how much and what else – must be quickly followed by filling out the accident report. Secure the scene and preserve any evidence. Take photos of the scene. Diagram how it happened. Record eyewitness testimony and have them sign their statement. Keep detailed notes of everything you see and what’s said. If possible, obtain an urgent care or emergency room report.
4. Not obtaining a medical release
A million things are happening at the time of the injury, and no doubt their supervisor is ruffled. Our claims adjuster will most likely have the injured employee sign a medical release right away that spells out what should be released, and for what time period. That way, the adjuster has immediate access to medical records so that the decision regarding compensability can be made more quickly. This provides additional intel to the adjuster – and gets the employee back on the road to health faster.
5. Not communicating adequately with the injured worker
Depending on the severity of the injury, their employee is frightened. What your client says or gives them to read may not be comprehended fully. That’s why it’s important to over-communicate, offering reassurance with regards to their workers’ benefits and their ability to return to their job. Reassurance can mean the difference between trusting their employer or hiring an attorney to handle their needs.
6. Not actively staying in the loop
Because so many parties are involved – your client, the injured worker, medical care, and the claims administrator – it’s crucial to ensure all communication is flowing smoothly. In addition to the accident report, you may need to provide the worker’s personnel file and payroll history. Work with the adjuster to manage the case to minimize any workers’ compensation claim mistakes and achieve the best outcomes, both in health care and return to work (light) duty.
7. Not having a return-to-work program
Your return-to-work program helps minimize and even eliminate lost-time claims by bringing their employee back sooner in a light-duty capacity. It helps the injured worker realize his value to the organization, and it makes management a hero to all of his or her coworkers.
Encourage your client to brainstorm with their supervisors on light duty possibilities. It’s possible that there are few tasks that can be performed within the worker’s old role, so they may need to pull in other supervisors to offer additional tasks to make up a light duty job temporarily. Then add back in some of the worker’s old tasks when she is able to perform them, working her back in to her old role.
Avoiding these workers’ compensation claim mistakes will not only make the claims process easier and bring back an injured employee faster, but it also can help your clients save money by reducing insurance premiums.
This blogpost originally appeared on Arrowhead Tribal website, but has been modified, updated and posted with permission to better apply to the needs of ICA's clients.
Know 8 Costly Mistakes Workers Comp Adjusters Make | Work Comp Resource Center
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