BEST PRACTICES: Managing Workers’ Compensation Claims
Employers must be willing to drive effective workers’ compensation (WC) claims management, and the best place to start is with communication. Good communication among all parties is crucial to ensuring a smooth claim process and achieving the best possible outcome.
Employees often seek legal counsel when they are injured and off work because they feel alienated from their employer and uncertain about where they stand. Make sure the manager or supervisor checks in with the employee on a regular basis.
Make sure your insurance team knows if you are receiving less than adequate communication and response time from your carrier and be open to exploring ways to improve communication with your business partners.
During the life of a claim, documentation of conversations with the injured employee, return to work slips, offers made of return to work, the employee’s medical status, and also what your internal policies are regarding light duty, FMLA, etc. can be useful information if any legal issues arise in the future. Current, detailed documentation regarding employee performance issues can also be useful.
Poor documentation can put you on a losing end of a WC claim if the claim enters the legal arena. Even the best claims with the best employees can go bad; you never know what direction the claim will take, so your best defense is good documentation all the way through the life of the claim. Remember, if it isn’t documented, it didn’t happen!
RETURN TO WORK
The one area where you as the employer can help control claim costs and engage employees in staying productive is return to work (RTW). A written RTW policy should be provided to employees so they’re informed on what to expect if an injury occurs. Set clear expectations with injured employees that an updated return to work status report needs to be provided to the employer immediately following each medical appointment. You cannot manage the claim if you do not know the employee’s work status. Ask injured employees how their rehabilitation process is progressing, if physical therapy is improving their function and if they have any questions or concerns regarding their work injury situation.
An accurate job description is vital to managing WC claims. Job descriptions should be clear and accurate reflecting the essential job duties and physical demands of the job. The “essential functions of the job” will be needed once the employee reaches an end of healing or MMI (Maximum Medical Improvement) to determine if permanent restrictions will require any accommodations to safely perform their job. It may not be feasible for the employer to provide accommodations or the employer may elect to not provide accommodations for business reasons. If job descriptions are not accurate, the treating doctor will be unable to accurately make a decision regarding causation of the injury and adjust job restrictions in a timely manner during the healing period.
Establish and maintain relationships with area medical providers who understand your business and what you do, know your light duty policy and availability, and are willing to be a partner with you. Do not be afraid to send area medical providers information about your ability as an employer to accommodate light duty and invite occupational health doctors or urgent care providers to your worksite for a tour. This is a great way to start a positive relationship.
Your internal policies need to be well documented, communicated, and in place prior to a work injury. Some examples of policies that are important to managing claims effectively include prompt injury reporting, return to work, accident investigation, and administering FMLA concurrently with a work injury.
Clear policies that are well communicated help all parties involved avoid confusion. Employees and supervisors should know what these policies are and they should be part of the day to day culture at your worksites. If you have a policy, you also need to be willing to enforce it with disciplinary action when necessary.
Educate yourself on WC laws in your state and procedures your carrier has for handling and administering claims. Seek out resources your agent provides to help you – knowledge is power! Be reasonable in your expectations, though and do not expect to be a WC expert overnight. It takes many years of handling many situations to become savvy about WC. In the meantime, know who you can go to with questions or concerns.
Report all injuries promptly, including ‘incident only’ injuries to your WC carrier. Make prompt injury and incident reporting a part of daily life so that you and your carrier can effectively manage claims. Trying to manage something internally and then reporting it to the carrier once it gets out of hand puts your carrier at a real disadvantage for trying to manage the claim. By promptly reporting, you give the carrier every advantage to complete a good investigation of the matter and communicate the findings to you.
ATTITUDE and CULTURE
The attitude your organization establishes in handling WC injuries can work for you or against you. Be sure to establish a culture of employee safety, care and concern for your employees, but also show you can be tough and fair on handling issues such as return to work and accident investigation. Be open to the fact that sometimes, no matter what you do or how hard the carrier or your agent works for you on a claim, the claim can still go sour and not produce the outcome you are looking for. Be able to realize the difference between someone ‘dropping the ball’ and simply not achieving the outcome you were hoping for.