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SAFETY TIP: Actively Manage Your Injury Claims in Workers’ Comp

By Eric Stiles posted 08-10-2016 11:08 AM

  

One of the best ways to control your costs from employee injuries is to decrease the employee’s recovery time away from work. Studies show that the longer injured employees are away from work, the less likely they are to return to the same job with the same physical abilities they had before the injury. By being active in the recovery process, you can help the injured employee through support and modified work assignments while reducing the overall cost burden on your business.

Establishing workers' compensation claim management strategies helps employers comply with the law while looking out for employees’ welfare. Follow these 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 following section for details on Responding to an Injury.)
  • On 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 doctor. (Emergency situations are not covered by this procedure.)
  • Instruct the injured employee to return to the workplace, if appropriate, after the doctor visit and report on the treatment given.
  • Make a thorough investigation of 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 closely with the doctor to secure medical information, and the type of work that can be performed by the injured employee to determine when the employee can return to work.
  • Maintain ongoing communication with the employee to monitor recovery progress and assist in early return to work.
  • Put the employee on alternative 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 information in your personnel records for disabled 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 selection of doctors, choose objective doctors who have knowledge of workers’ compensation laws.
  • Set up an effective safety program which 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
  • 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. Your safety consultant can help train your supervisors to conduct an effective accident investigation.
  • Complete your state’s First Report of Injury. Use your accident investigation report to record all information accurately and completely.
  • Prompt notice to your insurance carrier of any potential claim situation is critical.
  • Set up a claim file and stay current on case history information.
  • Maintain good communication with health care providers, the injured employee and your claims representative.
  • Send a detailed job description to the treating physician and your 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 early return to work based on the employee’s ability to work.
  • Contact the injured employee within 24 hours. Maintain weekly contact to communicate your commitment to his or her well-being. Discuss the doctor’s diagnosis and treatment planned, 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.

Article provided by Sentry Insurance, MTI’s Official Business insurance carrier.  Sentry has a complete division that specializes in the metal working industry.  If you would like a free analysis of your business insurance, you can contact MTI’s special representative, Eric Stiles at eric.stiles@sentry.com.  

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