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5 Things You Must Do When a Workers' Comp Claim is Filed

Julie Copeland

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Having a solid safety program in effect can prevent many injuries and significantly reduce your workers’ compensation exposure. But work-related injuries are not completely avoidable. OSHA reports that each year, over 4.1 million American workers suffer a serious job-related injury or illness. Once the injury occurs, your focus needs to shift from injury avoidance to limiting the impact of the claim on your business operations and your bottom line.

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Here are five general strategies to reduce your exposure after an injury occurs.

Be Proactive

Once an injury occurs, report it promptly to your workers’ compensation carrier or third party administrator (TPA), and work with claims personnel to complete a timely investigation of the injury. Many states require that the decision to either accept or deny a claim be made within several days of the injury report. Interviews with the injured employee witnesses and supervisors should be quickly conducted and your opinion of the compensability of the claim should be discussed with your claims adjuster. If you think the claim should be contested, provide your claims professional with the ammunition, he or she needs to defend the employee’s allegations.

Know Your Doctors

Most states require injured workers to be treated with medical providers who have been approved by their employer, at least at the beginning of the claim. Yet many employers don’t’ take the time to create a list of approved providers, don’t’ properly post the list or fail to meet the jurisdictional requirements to notify employees of the requirement to be treated with the “panel doctors”. Once you have established your list of providers, get to know them. Invite them to your facility to observe the regular and light duty jobs being performed, so that they can make informed return-to-work decisions.

Bring Them Back to Work

Employers who make the most effort to accommodate injured workers will consequently have the lowest number of lost-time claims. If the employee refuses an offer of light duty employment, wait a few weeks and make the offer again. If you can, try to accommodate the restrictions of the employee’s treating doctors – not just the restrictions of the panel or IME doctor. Judges and referees look favorably upon employers who continue to make good faith efforts to return an injured employee to work, even after the employee has turned down one or more previous offers.

Monitor the Claim

Your job doesn’t end once you turn the claim over to your insurance company or TPA. If you receive a petition or hearing notice in the mail, email it to your claims adjuster. I once represented an employer in a case where the employee ultimately received over $150,000 in compensation benefits for an injury that did not occur, solely because the employer failed to send the claim petition to the TPA, resulting in a late answer to the petition. The employer, unfortunately, assumed that the TPA was “taking care of everything.” But the TPA had not received the petition, and “service on the employer” was all that the employee needed to prove to secure a default judgment in this jurisdiction. I eventually won the case on appeal and my client was awarded a reimbursement of the benefits paid (but the reimbursement was from the State, not the employee).

Don’t Let it Get Personal

Many times, employers want to contest seemingly compensable claims because the injured worker is a “problem employee”. While it may feel good in the short term to deny benefits, litigating and losing a case eighteen months down the line can turn a $5000 claim into a $100,000 claim. Often, the employee is terminated during the course of a lengthy litigation and a return to work at light or full duty is no longer an option, even though the employee is fully capable of returning to work.  As they say, “accidents will happen.” Most claims, however, can be successfully limited, through the dedicated work of your in-house workers’ compensation team and your claims professional.

This article first appeared in our new digital magazine Safer Every Day and was written by leading workers' comp attorney Matt Wynn. Click here to receive your complimentary subscription and get industry insights as well as all the information you need to keep your workers safe.

Have a safe day!

Topics: workplace injury, workers compensation, workplace safety, workers compensation claims

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