Why Prompt Claim Reporting MattersThe Workers Compensation system is designed to provide employees with the proper medical treatment needed to recover from their work related injury or illness, partially replace their wages during recovery, and help employees get back to work.
Effectively managing workplace injuries or accidents will help reduce your overall costs and help your employees getting back to productivity. Whether it is the owner, supervisor or human resources manager, your office should identify a claims reporting point person and establish a first report of injury process. This can help ensure proper steps are consistently followed for each new workplace injury, enabling timely access to quality medical care and helping control future claim costs.
Industry studies demonstrate strong links between the speed with which a workers’ compensation injury is reported and the overall cost of the claim. Delays can contribute to higher cost and missed opportunities, it can also lead to increased employee anxiety, confusion, and unnecessary litigation. In some states, if a claim is not reported in a timely manner it can give the insurance company justifiable cause to deny the claim.
Major benefits to prompt reporting:
- Preserves key evidence and witnesses. Memories are infinitely fragile and allowing the claims adjuster or workplace supervisor to interview key witnesses early allows for less mis-information and potential lost evidence.
- Fraud prevention. Many employers have stories of the Monday morning back injury that was really from a flag football game over the weekend. If the claim was not reported promptly it lessons your ability to identify what actually happened.
- Avoiding bad publicity & potential fines. There can be reputational and financial harm due from not reporting actual claims.
- Provide quality care. When your employees are hurt, you want them to be able to have timely access to medical care as opposed to letting a situation fester and their condition worsen.
- Facilitate an earlier return to work. Your employees make your business run smoothly and productively, getting them back sooner boosts your efficiency.
- Conduct post-incident drug or alcohol testing. If you suspect the injury was caused by alcohol or drugs your carrier may be able to reduce benefits or some cases altogether deny a claim.
- Reduce costs. Timely reporting of a workplace injury mitigates the costs of a claim in several ways. The employee obtains prompt treatment, which reduces the likelihood of the injury worsening and the resulting medical costs increasing. Additionally, your carrier can investigate the claim promptly and ensure the injured employee treats with approved providers within the carrier's medical panel. Treatment outside the panel can significantly inflate the costs of a claim. Finally, prompt reporting allows your carrier to deliver potential benefits in a timely manner. Failure to do so could result in fines or increased payments to the employee.
- Promote claim compliance. Prompt reporting of a workplace injury promotes compliance to state workers' compensation guidelines. Most states require an employee treat within certain parameters and with specific providers for a set period of time (e.g., 90 days). An employee who is contacted by your carrier in a timely manner will be more inclined to follow these guidelines and also work directly with you and your carrier toward resolving the claim.
Once a new workplace injury or accident occurs, please take the following steps:
- Notification. The injured worker should immediately notify their employer of the incident. If the employee needs immediate treatment they should continue to step 3, if not, you can file an incident report and flag for follow up.
- Reporting Form. Each state has different reporting requirements and forms for employers to fill out but most forms contain information about the employer, insurance carrier, employee’s personal information, description of injury or illness, medical treatment, questions regarding return to work, and the employee’s payroll information.
- Treatment. The injured worker should seek treatment from your approved medical panel facility. The employer should ensure that the worker has the appropriate transportation to any panel facility.
- Stay Involved. Staying proactively involved with your claim adjuster and employee is paramount to helping ease their concerns and managing claims costs.
- Return to Work. Have a plan in place to accommodate light duty restrictions. Remember, the goal is ultimately get your employees back to work.
Sovereign has been assisting our clients with effective Workers Compensation claims management for over 50 years. Please contact us if you’d like help in developing an effective program for your organization.