Workers Compensation Claims 101 – What an employer should know

Workers compensation claims drive the workers compensation machine! You see it’s really not all about the cost of a workers comp policy, but about the services it provides to the employer and injured worker. First, let me warn you that you’ll find nothing new in this post! It’s just a refresher course on workers comp claims and losses, the process, their effect on injured workers and their effect on an employers premium.

Claims happen! It’s a fact of life that people get hurt on the job. When an employee gets hurt on the job the workers compensation system steps into the shoes of the employer and makes sure the injured employee is provided with proper medical treatment and lost wage replacement. Without a workers compensation policy the employer and employee would have no protection. They would be forced to settle the claim through the court system. The employer would be exposed to civil action and the employee would have no guarantee that they could receive the required medical attention while all along both incur the cost of litigation.

The term is “exclusive remedy.” That’s where the employee gives up their right to sue the employer for the injury and the employer agrees to provide benefits outlined by state statute to the injured employee. Exclusive remedy comes with responsibilities.

You’ll find that the individual state where an employer conducts operations will dictate, through statute, when an employer becomes subject to their workers compensation act. That’s an important thing for an employer to know! You’ll also find that, in most states, when an employer secures a workers compensation insurance policy from an insurance company they will have met their obligation under the act.

When an employee is injured on the job it is the employers responsibility to make a first report of injury (report the claim) to the insurance company. Early reporting of a workers compensation claim is of the utmost importance. It allows the insurance company to quickly assign an adjuster and to make immediate contact with the injured employee. The sooner an adjuster is in contact the better the claim will progress. As an employer you do not want to just report the claim and turn your back! That may be the worst thing you can do. You’ll find it doesn’t take long for a workers comp claim to get off track when no one is paying attention. Insurance company and employer contact with the injured worker is a must! Think about it. When a claim occurs it’s more than likely the first time the employee has ever been injured on the job and they need to know what to do, what to expect and that the employer wants them back on the job as soon as they are medically capable of performing their work again. Common sense right? Well, when it comes to common sense, injured workers, workers compensation claims and an employer, sometimes common sense goes out the door!

What an employer should know about workers compensation claims:

  • Seek immediate medical attention for the injured worker.
  • A claim needs to be turned in to the insurance company as soon as possible.
  • Followup by the employer is of utmost importance! Once a claim is turned in, don’t turn your back on it! Get involved and stay involved by making contact with the claim adjuster assigned to handle the claim.
  • Keep communication lines open. Talk with the adjuster on a regular basis and keep in touch with your injured employee.
  • Perform an incident investigation. Develop your own form that is used to gather specific information about the claim, what happened, how it happened, when it happened and what the injured workers were doing. Who was involved and what could have been done to avoid the injury. This investigation is not to place blame but to identify safety hazards that may be improved so as to avoid future injuries and claims.
  • Serious injury and death claims will be investigated by OSHA and or other government authorities. Safety of workers a safe workplace is taken very serious by these organizations. If safety violations are found serious fines may be imposed on the employer.
  • Claims will affect your premium for a three-year experience period if your policy is experience rated. Look to an independent workers compensation consultant to have your experience modification rate verified every year.
  • Employers who have written procedures for handling a workers compensation claim will be ahead of the game! When a claim occurs is not the time to be figuring out what to do! Develop a safety program and outline what needs to happen when a claim occurs.
  • Employers who have return to work programs will benefit by getting the injured worker back to work.
  • Develop a real safety program. Not just something put on paper that no one reads or follows but develop an active safety program with participation from your workforce. It’s better for everyone.

See, most of these items are just common sense.

The Take Away: The two most important things an employer can do when faced with an injured worker is first to immediately seek medical attention and the second to get the claim turned into the insurance company! But don’t forget all the other stuff.

Hope this refresher helps you out! Thanks!