At the 2017 Business Insurance/CLM Workers’ Compensation Conference a panel addressed key elements for employers with their pre and post accident process from the perspectives of a corporate claims manager, insurance claims specialist and defense counsel. The panel was:
- Judith Cole – Corporate Claim Manager – K2 Industrial Services Company
- Stephanie Wood – Claims Manager, The Wendy’s Company
- Kristen Kaiser Kus – Attorney, Bryce Downey Lenkov LLC
- Melissa Donovan – Claims Specialist, Cincinnati Insurance Company
The claim process actually starts with the employee on-boarding process. Your employee manual should contain information about reporting a workers’ compensation claim. Timely reporting of accidents is critical for prompt investigation and delivery of benefits. Make sure the state mandated posters are in the appropriate locations with information about where to report an accident. Your supervisors need to be involved in the claim reporting process to ensure information is delivered timely to the appropriate channels.
Safety is another key element in your pre-accident program. Employees must be trained on all safety protocols and these must be strictly enforced. Make sure you employees are using safety equipment correctly and consistently. Check equipment routinely to ensure it is in good working order. If the employees are not using safety equipment properly, or it is defective or lacking, then you have a gap in your loss prevention procedures.
It is important to document the personnel file appropriately with things such as safety violations, job performance issues, and excessive absenteeism. Occasionally, after the employee files a claim the employer will tell the claims handler this was a “problem employee” but the personnel file does not reflect this.
The importance of timely accident reporting cannot be stressed enough. Get the information to the carrier/TPA asap. If medical treatment is needed, they need to be referred out quickly to the appropriate provider. Not all states allow you to “direct” care, but that does not mean you cannot provide the injured worker with a referral to an appropriate occupational medicine facility that is pre-approved to treat your injured workers.
Investigation of the accident is an important piece of the claims process where errors often occur. The employee should be contacted within 24 hours to obtain their statement regarding the facts of the accident. The claim handler should speak to the employer for background information that may assist in the claim handling. The accident investigation should be thorough making sure to get accurate information about the cause of the accident and injuries that occurred. Find out about potential witnesses and if they exist get statements from these individuals. Ask questions about pre-existing physical conditions that may have an impact on the claim.
During the investigation it is important to get an accurate job description for the worker. This is essential for determining their ability to return to their regular job or whether modifications may be needed. This information needs to be provided to the treating physician immediately. It is also very important to have a good return to work program in place so that you can get the injured worker back as soon as possible. This is good for both the injured worker and the employer. If there are some standard modified duty job positions available you should get those and send them to the treating physician.
Make sure you obtain the necessary medical release forms from the injured worker. These will ensure you are able to get the records timely so that the claim can be processed accordingly.
If you have concerns about the legitimacy of a claim, social media can provide a significant amount of information about the injured worker’s activities. People love to share what they are doing on social media and this can work to your advantage with a questionable claim.
If the employee is released to modified duty, it is very important that you follow those restrictions closely so the employee does not aggravate the injury.
Finally, make sure you are coordinating any workers’ compensation absences with your human resource absence policies. ADA and FMLA rules apply to a workers’ compensation claim so you cannot ignore these issues.