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Worker’s Compensation Management Strategies Benefit Employees and Employers

By Tom Morrison posted 04-28-2015 09:18 AM

  

By: Troy Tepp, MS, CSP – Sentry Insurance Director of Safety Services

Establishing workers’ compensation claims management strategies can help employers comply with the law while also benefiting employees’ welfare. Follow the below strategies to maintain an effective workers’ compensation policy:

  • Adopt a policy to have all injuries reported to the supervisor or management immediately. Many states levy fines if claims are not reported promptly. It is extremely important that the First Report of Injury is sent to the claims department right away. See the following section for details on responding to an injury.
  • For any claims where you are not satisfied that the injury occurred on the job, contact your insurance claims representative so a thorough and confidential investigation can be initiated.
  • Set up a policy to have all employees report to a designated management person to secure proper authorization before seeing a physician. (Emergency situations are not affected by this procedure.)
  • Instruct the injured employee to return to the workplace, if appropriate, after their visit to the physician and report on the treatment given.
  • Thoroughly investigate each workers’ compensation injury. Check with the supervisor and any other witnesses and inspect the workplace. Review the supervisor’s accident investigation report.
  • Follow up with the treating physician to secure medical information, to determine when the injured employee can return to work, and to find out the type of work that can be performed by the employee.
  • Maintain ongoing communication with the employee to monitor recovery progress and assist in an early return to work.
  • Put the employee on alternative or modified duty status when necessary. Encourage the physician to suggest specific work capabilities and limitations. The physician should be encouraged to have the employee return to work midweek, if appropriate, rather than wait until a Monday, to help ease the transition back into the work environment.
  • Maintain a record of employees who are listed in the Second Injury Fund in your state. If an employee has a second injury, notify the claims department and give them this important information.
  • Notify the claims department if an injured employee who is off the job is active in other areas or working elsewhere.
  • Use a job placement application consistent with the Americans with Disabilities Act (ADA) provisions. Set up a selection plan to identify and evaluate critical job demands in compliance with the ADA.
  • Where state law permits the selection of physicians, choose objective physicians who have knowledge of workers’ compensation laws.
  • Set up an effective safety program that assigns accountability to all operating personnel.

Responding to an Injury

Responding quickly and effectively to an employee injury is a critical factor in the ultimate outcome of a workers’ compensation claim. Delays in reporting and missing details about the nature of the worker injury may slow the claim investigation process, delay benefit payments to the injured worker, or prompt the employee to seek unnecessary legal advice.

If ignored, even minor injuries can evolve into major workers’ compensation claims. That’s why a supervisor’s response and management’s reaction are critical, especially if the injury involves lost work time.

Steps to Follow

  • Assure prompt medical attention for your injured employee, based on your company emergency response plan.
  • Conduct an investigation to determine any underlying causes of how and why the accident occurred.
  • Complete your state’s First Report of Injury. Use your accident investigation report to record all information accurately and completely.
  • Promptly notify your insurance carrier of any potential claim situation.
  • Set up a claim file and stay current on case history information.
  • Maintain good communication with health care providers, the injured employee and your insurance claims representative.
  • Send a detailed job description to the treating physician and your insurance claims representative so they are aware of the job-related activities performed by the injured employee.
  • Contact the physician within 24 hours to discuss diagnosis, treatment provided and planned, and provisions for an early return to work based on the employee’s physical capabilities.
  • Contact the injured employee within 24 hours. Maintain weekly contact to communicate your commitment to his or her well-being. Discuss the physician’s diagnosis and planned treatment, and answer any questions the employee may have. Be sensitive to the employee’s concerns and welfare.
  • Maintain a log of all contact with the treating physician and injured employee to document questions, concerns and progress.

Property and casualty coverages and safety services are underwritten, issued and/or administered by a member of the Sentry Insurance Group, Stevens Point, WI. For a complete listing of companies, visit sentry.com. Policies, coverages, benefits and discounts are not available in all states. See policy for complete coverage details.

This document is made available by Sentry Insurance a Mutual Company and its subsidiaries and affiliates (collectively “SIAMCO”) with the understanding that SIAMCO is not engaged in the practice of law, nor is it rendering legal advice. The information contained in this document is of a general nature and is not intended to address the circumstances of any particular individual or entity. Legal obligations may vary by state and locality. No one should act on the information contained in this document without legal advice from competent and licensed local professionals. THE INFORMATION CONTAINED IN THIS DOCUMENT IS DISTRIBUTED BY SIAMCO “AS-IS”, WITHOUT ANY WARRANTIES.  SIAMCO WILL HAVE NO LIABILITY TO ANY PERSON OR ENTITY WITH RESPECT TO ANY LOSSES OR DAMAGES CAUSED, OR ALLEGED TO HAVE BEEN CAUSED, DIRECTLY OR INDIRECTLY BY THIS DOCUMENT, REGARDLESS OF WHETHER SUCH CLAIM IS BASED ON CONTRACT, WARRANTY, TORT (INCLUDING NEGLIGENCE AND FOR PROPERTY DAMAGE AND DEATH) OR OTHER GROUNDS.

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