Top 10 Workers Compensation Claim Handling Mistakes
Mistakes are measured in time and dollars. Makes sure you avoid these 10 mistakes.
- Failure to Make a Timely Report of the Claim
When claims are not reported timely the result is a loss of valuable time and information. When a report is received early the investigation is easier as memories are fresh and evidence is preserved.
It also allows the claim representative to work with the medical provider to keep your injured employee working in a light duty capacity, thereby avoiding a lost time claim.
- Failure to Investigate at the Time of the Injury
The injured worker’s immediate supervisor is the best investigator on a workers’ compensation claim. They typically have the most knowledge of the job and the closest relationship with the injured worker. This can be vital in determining if a reported injury is plausible or not. They may also have some insider knowledge about the worker’s extracurricular activities. All information that may impact the claim, including witnesses should be communicated to the claim representative immediately.
- Insufficient or Lack of Documentation of the Details of the Accident/Injury
Keep complete and detailed notes throughout every step of an internal investigation. All statements should be written and signed. Take immediate steps to preserve evidence and secure the accident scene. Take pictures and make diagrams if appropriate.
- Losing Touch with an Injured Worker
You damage your trust with your injured worker if you fail to stay in touch with them at the onset of the injury and provide information to them at how the claim is handled. Keeping the worker informed makes them feel comfortable with your organization and its motives. It also keeps the worker from feeling alienated and possibly retaining an attorney.
- Not Securing a Medical Release at the Time of Injury
To avoid delays in obtaining medical records and delaying the compensability decision you should have the claimant sign a medical release, if possible, at the time of the injury.
- Not Having a Transitional or Modified Return to Work Program
Companies with comprehensive modified work programs can minimize or eliminate lost-time claims by bringing and injured worker back to work sooner. It also helps the worker feel that they are valued by the organization.
Identify activities that injured workers can do within your organization to bring them back as they heal and help your employees identify additional skills they possess to fulfill needs of the organization.
- Treating the Injured Worker and the Medical Provider with a Passive Attitude
Pro-actively dealing with injured workers and doctors is the right approach to minimize your claim exposure. Develop a rapport between the provider, your organization and the injured worker to cooperatively bring the employee back to work successfully.
- Lack of Understanding about Workers’ Compensation in General
Know the laws in the States where you do business. Some States allow the employer to direct care to a preferred occupational health clinic or doctor. When you can’t direct care, provide a panel list of doctors which the employee can choose from if they ask for treatment options.
- Hiring Unqualified Employees and Not Enforcing Proper Job Safety
Make sure that employees are qualified and trained to safely perform the functions of their job. Regular employee safety training on the proper use of equipment and how to identify and deal with potential hazards will greatly reduce accidents.
Provide clearly written safety rules and implement initiatives that promote and reinforce workplace safety. Document when an employee passes training course and other certifications. This information may be useful in the investigation and defense of a claim.
- Failure to Keep in Touch with the Claim Representative
Form a partnership and work together to manage the claim and reach proper resolution of all issues. Ensure that there is agreement on targets for return to light duty, regular duty and completion of medical care.
When trying to control your organizations workers’ compensation claims it is imperative that the appropriate actions are executed promptly and correctly.