Avoid the top seven workers’ benefits claim mistakes
Workers’ benefits claims are potentially part of every tribal business, whether your company only employs workers sitting all day at desks, construction workers or medical staff. Wherever there are people working, there’s the potential for a work injury. That’s why you have insurance.
Regardless of your entity’s particular risk for work injuries, it pays to know what the top risks are, and how you can avoid them. Forewarned is forearmed, they say.
You already know to ensure you’re hiring employees properly qualified for the job. You’re training new hires how to safely perform job duties. And you’re continuing regular (and documented) safety training for all employees, focusing on proper use of equipment and how to identify and handle potential hazards.
However, in spite of your best efforts, an employee has been injured and you’re faced with a claim. Here are the top seven workers’ benefits claim mistakes seen most frequently, along with how you can avoid them:
1. Waiting to report the workers’ benefits claim
Not reporting a claim right away is a bad idea that will cost you money in the long run, we showed you in an earlier post on same-day reporting vs. delayed reporting. Our claims administrator, American Claims Management (ACM), found that when a worker’s compensation claim was reported more than 10 days after the event, costs rose by 60 percent on indemnity claims, and by 64 percent on medical claims. Even if the incident appears to be minor, it’s still best to report it in “report-only” mode, which alerts us to the accident without turning it into a formal claim. This actually protects you if and when it does become a more serious claim, as we explained in a post on the benefits of speedy workers’ compensation claim reporting.
Filing right away does two things: it allows the investigation to begin immediately, while details are still fresh in everyone’s minds, and it also assures the injured worker receives the proper care and attention so that they can recover more quickly – again, saving you money.
2. Failing to investigate immediately
“The best investigator on a workers’ compensation claim is the injured worker’s immediate supervisor,” said James Ryan, senior vice president of field claims at SRS. Why? Because the supervisor understands the job role and duties and has valuable insight into where the injury occurred and if there were any extracurricular activities that might impact the claim. The supervisor also knows the claimant and coworkers, and can quickly gather eyewitness reports. These details are crucial to the adjuster who will be investigating the claim, and will help you minimize any workers’ benefits claim mistakes.
3. Not sufficiently documenting the accident details
Asking all the right questions – the who, what, when, where, how, why, how much and what else – must be quickly followed by filling out the accident report. Secure the scene and preserve any evidence. Take photos of the scene. Diagram how it happened. Record eyewitness testimony and have them sign their statement. Keep detailed notes of everything you see and what’s said. If possible, obtain an urgent care or emergency room report.
4. Not obtaining a medical release
A million things are happening at the time of the injury, and no doubt your supervisor is ruffled. Your claims adjuster will most likely have the injured employee sign a medical release right away that spells out what should be released, and for what time period. That way, the adjuster has immediate access to medical records so that the decision regarding compensability can be made more quickly. This provides additional intel to the adjuster – and gets your employee back on the road to health faster.
5. Not communicating adequately with the injured worker
Depending on the severity of the injury, your employee is frightened. What you say or give them to read may not be comprehended fully. That’s why it’s important to over-communicate, offering reassurance with regards to their workers’ benefits and their ability to return to their job. Your reassurance can mean the difference between trusting you as their employer or hiring an attorney to handle their needs.
6. Not actively staying in the loop
Because so many parties are involved – your company, the injured worker, medical care, and American Claims Management (your third party claims administrator) – it’s crucial to ensure all communication is flowing smoothly. In addition to your accident report, you may need to provide the worker’s personnel file and payroll history. Work with ACM’s adjuster to manage the case to minimize any tribal workers’ benefits claim mistakes and achieve the best outcomes, both in health care and return to work (light) duty.
7. Not having a return to work program
As mentioned in an earlier post, your return-to-work program helps minimize and even eliminate lost-time claims by bringing your employee back sooner in a light-duty capacity. It helps the injured worker realize his value to the organization, and it makes you a hero to all of his coworkers.
Brainstorm with your supervisors on light duty possibilities. It’s possible that there are few tasks that can be performed within the worker’s old role, so you may need to pull in other supervisors to offer additional tasks to make up a light duty job temporarily. Then add back in some of the worker’s old tasks when she is able to perform them, working her back in to her old role.
Avoiding these workers’ benefits claim mistakes will not only make the claims process easier and bring back an injured employee faster, but it also can help tribal businesses save money by reducing insurance premiums.
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