7 Tips for Workers’ Compensation Claims

7 Tips for Workers’ Compensation Claims

Workers’ compensation claims can be costly to an organization, especially if they aren’t managed well. Here are seven (7) tips for employers in managing workers’ compensation claims cost-efficiently and correctly.

1. Promptly report all claims to the insurer.

Effective case management begins with timely reporting of your workers’ compensation claim. The more quickly an injured employee reports a claim, generally, the more smooth the claims process. When claims are reported in a timely manner, evidence can be preserved and the claim can be better resolved; workers can start treatment sooner; fraudulent claims can be identified more quickly; and you can avoid potential monetary fines/penalties for failing to report claims.

In addition, to avoid delays in obtaining medical records and delaying the compensability decision, employers should have the claimant sign a medical release, if possible, at the time of the injury.

2. Provide training to supervisors.

It is very important that supervisors understand the workers’ compensation process so that they know what to do when an injury occurs, can direct employees to the appropriate individuals, help determine if a claim is valid, assess the validity of a potential claim, manage work restrictions, and assist in getting an employee back to work in a timely fashion. In addition, supervisors should be trained on the cost and impact of workers’ compensation, and be held accountable for preventing injuries (Source: SHRM).

3. Investigate at the time of the injury and keep complete notes.

You must treat every injury as legitimate and investigate it. Early, if not immediate, investigation is best, if possible. Investigations should include the following:

  • Obtaining facts about the incident
  • Identifying and talking to witnesses
  • Interviewing the supervisor; generally has the most knowledge of the job and is closest to the worker
  • Securing the scene of the accident and preserving evidence
  • Taking pictures and making diagrams

Similarly, don’t decline a questionable claim immediately. Wait until the investigation is completed and all facts are in before prematurely confronting an employee about filing a suspected fraudulent claim. If you accuse an employee and, in fact, it turns out that the claim is valid, you could face a lawsuit.

4. Communicate with all parties frequently.

Communicating the workers’ compensation process, how to report an injury, when the worker can expect benefits, key issues such as how to return to work (if necessary), and whom to contact with questions is important. It’s critical to stay in touch and communicate with the employee frequently while they are on workers’ compensation as well as with his or her health care provider regarding the status of their condition.

In addition, stay in touch with the claim representative/case manager. Form a partnership and work together with the claim representative/case manager to manage the claim and reach proper resolution of all issues. Ensure that there is agreement on targets for return to light duty, regular duty, and completion of medical care.

5. Create a return to work program.

Companies with comprehensive return to work programs can minimize or eliminate lost-time claims by bringing an injured worker back to work sooner. It also helps the worker feel that they are valued by the organization. Identify activities that injured workers can do within your organization to bring them back as they recuperate and help your employees identify additional skills they possess to fulfill other needs of the organization.

6. Prevent employees from injuries.

The main way to prevent employees from getting injured on the job is to develop a comprehensive safety program, and routinely train employees and managers on it. Also, consider implementing a safety-oriented culture and establishing either an individual or committee in charge of safety programs.

Also, regularly track and review your company’s claims history and take steps to reduce the chances that further similar claims will be filed. Are there any trends or patterns? Data on claims can point to deficiencies in your organization’s approach to safety/risk management.

If so, more detailed training, instructions, changes to the work environment/equipment, or other improvement measures should also be implemented to prevent future injuries. In addition, keep track of patterns in reoccurring claims with certain employees. Patterns can point to fraudulent claims or unsafe working conditions, both of which need to be addressed.

7. Use a quality managed care organization.

A managed care organization is an alternative approach to workers’ compensation coverage. Employers in Ohio must choose a managed care organization (MCO) to deliver medical care to injured employees and manage their workers’ compensation claims, otherwise the BWC chooses one for the employer. Not all managed care organizations are created equal, and the best managed care organizations help organizations save significant costs on workers’ compensation claims. That’s why it’s important to choose an effective one.

To better manage your workers’ compensation claims, it is important to be familiar with the relevant process and regulations. These seven (7) tips would help you not only be empathetic with injured employees, but also practice superior cost-containment strategies to control claims costs.

Please note that by providing you with research information that may be contained in this article, ERC is not providing a qualified legal opinion. As such, research information that ERC provides to its members should not be relied upon or considered a substitute for legal advice. The information that we provide is for general employer use and not necessarily for individual application.

Sources: SHRM (2008). Workers’ Compensation Training for Supervisors; Legal and Employment Law Update (2012). Tips on Actively Managing Workers’ Compensation Claims; HNI (2010). Top 10 Workers’ Compensation Claim Handling Mistakes

Additional Resources

Workers’ Compensation Managed Care Organization

ERC endorses CareWorks as the preferred workers’ compensation Managed Care Organization (MCO) for members. CareWorks can deliver substantial medical savings through provider network discounts. These discounts can help employers reduce claim costs and help control future premiums,”

Workers’ Compensation Cost Management
ERC’s Preferred Partner, ERSco, works with employers to identify workers’ compensation claims that have the potential to generate the greatest losses and focuses on controlling all associated costs. ERSco is able to do this by providing legal expertise as well as financial/risk expertise in a coordinated effort with an MCO to truly control the total cost of risk.