One of the most important, yet toughest, part of running a business is ensuring safety for your employees. Providing a hazard-free workplace built on a strong safety culture is the first step to eliminate the potential for an incident or accident that results in a workers’ compensation claim. Unfortunately, though, accidents happen. If a claim does occur, no matter how minor, it is important to keep the following steps in mind so that you can minimize the cost and the chance of a small claim turning into a much larger, more costly claim.
Your Pre-Determined Medical Providers and Clinics
Here’s a simple way to be prepared; create a pre-determined list of nearby medical providers and clinics that are approved by your Workers’ Compensation Carrier. Ensure that this list is readily accessible to all supervisors, especially for offsite work assignments.
Nobody Gets Left Behind
Be sure to accompany your injured employee to the clinic or hospital. Most importantly, this provides the employee reassurance that he or she is not alone in this, and that your company is committed to getting the necessary immediate help and long-term help to get him or her back to work.
Additionally, this will ensure that the clinic or hospital administrator is aware that the situation is a worker’s compensation claim and you can provide them with your carrier’s information.
Get in Contact
Your next step should be to file the claim and obtain the contact information of the to be assigned claims adjustor. Be sure to check with your carrier for their reporting deadlines. The general rule of thumb is that a claim needs to be reported within 24 hours of notice, but the sooner the better.
By law, you must report the incident to OSHA within 24 hours of the incident occurring if the accident is serious and requires an overnight hospital stay. In the case of an amputation, loss of an eye or a fatality, OSHA must be notified within 8 hours of the incident occurring.
The first priority when gathering information is to obtain the full names and contact information of anyone who may have witnessed the incident. This is to ensure accuracy and enable you to thoroughly investigate the incident. This research should be accompanied by a written memo from your injured employee as to what occurred and what events that may have led up to causing the incident.
Pick a Claimant’s Advocate
Someone within your company needs to be responsible for ensuring that the claimant’s situation becomes rectified. This is the Claimant’s Advocate. The person who takes on this role does not necessarily have to be a worker’s compensation expert. Depending on the size of your company, it can be a role assumed by a mid-level employee who is organized, tenacious and does give up. The situation could be as simple as seeing that your injured employee, especially any with soft tissues injuries, gets a follow up appointment within a few days of the incident.
Communicate, Communicate, Communicate
Typically, an employee will make the decision on whether or not to seek legal help within the first five days of an incident. A claim can take a complete turn if the adjustor drops the ball and the employee is sitting at home, in pain, waiting to be seen by a doctor or specialist. This is why you’ll need that in-house Claimant’s Advocate. They will act as the liaison between the insurance company adjustor and the injured employee.
The average insurance claims adjustor could be handling 300+ claims at a time, and you cannot assume that your employee is top of mind. Needless to say, the Claimant’s Advocate needs to build rapport with the adjustor. Understanding the treatment plan and holding both the adjustor and the employee accountable to meeting that plan are an essential part of his or her job.
The first five days after the incident are key to managing the claim. The next obstacle the advocate might face that could lead an employee to seek legal representation is if the primary doctor recommends that the injured employee see a specialist. The Claimant’s Advocate needs to be in communication with the employee and primary physician’s office directly after the appointment.
It could take days for the actual written recommendation to be completed, sent and reviewed by the adjustor. Upon approval, the adjustor must locate and set an appointment with the specialist which adds additional days to the process. The Claims Advocate can help speed up the process on all sides while giving the employee progress updates.
The Return to Work Program
Having a program that can meet typical light duty restrictions is key is to getting the injured employee back to a work environment and out of the house. The simplistic goal of the program is to marry the injured employee’s care plan with a light duty assignment or job that is within his or her medical restrictions.
An effective program can also weed out employees that may be complaining of a soft tissue injury but can’t seem to bring themselves to follow through with a light duty work plan. The insurance company is not obligated to pay the employee indemnity payments and it can help lead to a speedier closure of the claim if the employee does not comply with working in medically prescribed conditions.
Keep your staff safe!
Injuries in the workplace can be detrimental to both employees and employers, but with the help of this list, you can provide the most safe and effective space possible for everyone.