Update: Workers Compensation Claims

Shellie L. Goetz
June 19, 2006 — 2,555 views  
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Controlling workers compensation costs requires consistent investigation and a standard claims management processes. In an on-the-job injury or illness, something happened, somewhere, to somebody. In the realm of workers compensation the something, somewhere, and somebody are the landscape of the claim. Employers must ensure there are standard procedures in place that include having management survey the landscape by investigating what happened, how it happened, and who did what after it happened. Have a post accident check list that includes inspection of the physical location where the accident occurred, preserving any visual depictions of the area, and record the facts that your insurance company or attorney may need later if the employee files a workers compensation claim.

The goal is to obtain and preserve evidence of what happened to whom and when because by the time the employee seeks medical treatment, talks to his friends about their cousin’s mother in law who got a workers compensation settlement, and then finally decides to make a workers compensation claim, vital details about the incident could be lost. By surveying the landscape of a work related accident or incident, your staff can preserve evidence that will assist your claims professionals and attorneys to better defend your interests.

In addition to surveying the landscape of every reported on the job injury, ensure that your managerial staff applies consistent procedures for each reported injury. For instance, ensure that your company has pre-determined health care providers for purposes of on-the-job injuries. Employers in most states are allowed to direct the medical care rendered to their employees in the context of workers compensation claims. Thus, it is critical to have a pre-appointed health care facility that all employees know will render treatment for on-the-job injuries. There are several points to consider when designating a health care facility (cost and accessibility are the primary considerations); however, it is critical that if an employee is injured on the job, she knows she is to report to XYZ facility, not her personal family medical doctor. Usually hospital emergency departments are expensive and it is more cost-effective to utilize the services of immediate care facilities for minor cuts, scrapes, bruises, and muscle strains. Of course, if the injuries are severe and may require immediate surgery, transport the employee to the hospital you have pre-selected for the treatment of workers compensation injuries. Each management staff person should know the identity and location of these health care providers. Aggressive medical management and oversight of treatment is the most fundamental method of controlling workers compensation costs. It is critical to ensure that the initial provision of treatment is properly directed in order to set the course for appropriate medical care and treatment through the pendencey of the claim. Employees need to understand, from the first date that they report their injury, that you, as the employer, will tell them which health care providers they will see and that all care, related to the on-the-job injury, will be managed by you or your insurance representatives.

Finally, to preserve the landscape of the accident or incident that precipitated the on-the-job injury, create a mandatory checklist that includes: (1) interview of the employee and take a tape recorded statement; (2) inspect the scene of the accident; (3) interview witnesses and take tape recorded statements; (4) obtain photographs;  (5) communicate with health care providers; and (5) make a timely report to your insurance company (or if you are self-insured, to the State Workers Compensation Board). Each injury and employee will present a different set of circumstances; however, your investigative procedures should be standard and consistent.

Shellie L. Goetz

Baker & Daniels LLP