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Eight Steps to Effective Workers’ Compensation Claims Management

These eight steps will help you create an effective workers’
compensation claims management procedure. But getting the first step right is probably the most important thing you can do to ensure you get all the other steps right, too.

1. Support a workplace where there is trust and mutual respect. A negative work environment almost invites workers’ compensation losses and can inevitably make them worse. Injured workers can often lack motivation to get better because they don’t want to go back to a workplace environment they feel is unfriendly, unwelcoming or distrustful.

2. Inform employees of the injury reporting process. The process should be part of the employee rules of conduct and provide clear step-by-step rules for employees to follow in the event of an injury. Employees should know to inform their supervisor of an injury as soon as possible, get emergency help if needed or at least see a doctor if necessary. Employees also need to know where to find easily accessible information about how to fill out a claim form, benefits available and the importance of rehabilitation and returning to work.

3. Establish procedures to ensure that injured employees get prompt medical attention in the most appropriate ways. This should include establishing:
A. relationships with occupational medicine practitioners who understand your business operations
B. an early return-to-work program
C. a referral program to appropriate medical specialists

4. Maintain a policy of reporting claims to your workers’ compensation carrier the same day they occur. If a claims adjuster is able to quickly respond, this will minimize the sense of uncertainty that often results when someone is injured and confused about whether their claim will be handled promptly and equitably.

5. Investigate the accident thoroughly. This is essential not only to quickly resolve the immediate claim and mitigate the loss but to prevent future losses. Your accident investigation should include:
A. Written statements from the employee-claimant and any co-workers or witnesses at the accident site
B. Written statement from the supervisor
C. Supporting documentation such as photographs of the accident site, information
about similar incidents at the site or similar sites and relevant loss prevention
reports that may have been filed on this matter in the past.
D. A review of all documentation with recommendations about corrective actions.

6. Maintain clear communications with the injured employee throughout the claims process. Help them understand the process, what to expect in terms of medical treatment, payments for their medical treatment and status of their pay. Remind them that you support them and want to see them back on the job as soon as possible. Lack of communication and a thorough explanation of how the claims process works is the biggest reason why injured workers retain an attorney.

This process can be quite a challenge for everyone, including adjusters, so stay involved. Many states have instituted reforms that can be confusing to all parties. It’s crucial that all parties keep in close and honest communication.

Eddy Canavan, Orange, California-based vice president of the workers’ compensation practice and compliance for Sedgwick Claims Management Services Inc., said new regulations can be a starting point for litigation. “My experience is whenever there are changes that impact human beings, there is some litigation that will result from that,” Canavan told Business Insurance magazine. For example, California and many states are now limiting how healthcare providers prescribe opioid painkillers. An injured worker needs to
understand that state laws are in play here, not employer or workers’ compensation insurer cost-cutting. “There could definitely be challenges with the formulary, and applicants’ attorneys will test it,” said Canavan.

7. Have an early return-to-work program. These programs are win-win. They help employees recover faster by allowing them to quickly return to feeling like useful contributors. And they reduce the costs of temporary total disability payments and minimize the impact on your experience modification factor.

8. Reach out to your broker for help implementing your workers’ compensation claims management process. We’re here to help you.

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