Workers’ Compensation is designed to provide medical coverage and lost time coverage to employees who are injured on the job or develop a work-related illness as a result of the work environment.  Unfortunately, determining if an injury or illness is work-related isn’t always easy for physicians to do.

During a recent visit to a client, she asked me how to handle a claim situation that she had in which the attending doctor couldn’t determine if the injury was work related. She said that she felt as though their carrier was approving all claims, regardless of the legitimacy of the claim.

So how do you ensure that you are getting the most out of your Workers’ Compensation carrier?

1. Train your staff. Make sure that anyone who will be responsible for submitting claims understands the process and what information to include in the claim documentation.
2. Document the scene. If the claim is the result of an accident, take pictures of the scene as soon as possible after being notified of the injury. Look for potential hazards that may have been in the area, caution/warning signage that was posted that was not properly followed, and any other clues that may help determine the validity of the claim. Send those along with your First Report of Injury to the carrier.
3. Communicate concerns. When an employee comes to you with a claim, you have to report it. But as the employer, you also have the right, and honestly the obligation, to let the carrier know if you have concerns regarding the validity of the claim. Include your concerns in the report sent, and if necessary, pick up the phone and call them once a claim number is established.
4. File Claims Immediately. Stress the importance of reporting injuries or illnesses immediately to both your managers and your staff. Failure to report a claim immediately, even a minor injury, could result in a delay or denial of claim payment. A delayed report of injury may also be an indication that the injury didn’t really happen at work, so be sure to obtain as much information regarding the reported injury as possible.
5. Implement a Return to Work Program. If your organization doesn’t already have one, put one in place. It will help to get injured employees back to work quicker and cut down on potential lost wage claims, as well as deter false claims.
6. Monitor your claims regularly. Audit your active claims on a regular basis. Stay in touch with the carrier on claims that are taking longer than usual to process, claims that have excessive payouts, or claims in which employees have missed an excessive amount of time away from work.
7. Build a relationship with your preferred physicians. Communicate with the physicians that you send employees to when they are injured on the job. Some physicians will be more open to communication with the employer than others. If you have an employee who is out of work, make sure the physician understands your Return to Work program and what type of light duty assignments you can offer the employee. It may help to get them back to work quicker.

The more information you are able to provide when submitting claims, the easier it will be for the carrier to properly assess the claim and make an informed decision.

Is your Workers’ Compensation carrier working for you?