Six Reasons for Promptly Reporting a Workers’ Compensation Claim

Author, Jeremy Hoolihan, Account Executive, Rancho Mesa Insurance Services, Inc.

Reporting workers’ compensation claims in a timely manner can have a huge impact on the severity of the claim. Some policyholders believe the practice of not reporting employee injuries early is a good business practice. This could not be further from the truth. Below are six reasons why reporting claims early can reduce the overall impact of a claim on an employer’s insurance premiums:

1. Lowers the cost of a claim – The cost of a claim gets higher and higher for each day it is not reported. Claims reported after 30 days of the injury on average cost 30% more than those reported right away.

2. Ensures that key evidence is secured – The prompt reporting of a claim allows the claims adjuster to ensure key evidence is preserved. It also ensures that the supervisor’s accident report and witness statements are taken while things are still fresh in their minds.

3. Potential hazards are identified as early as possible – When an injury or near miss occurs, there should be an accident investigation completed to find out the root cause of the injury. Identifying the cause or potential hazard will reduce the likelihood of a similar claim from occurring in the future. It can also be useful as a training topic during safety-related meetings.

4. Could identify “red flags” for fraud – It is very important to understand that an insurance company only has 90 days from the employer’s (or their management or supervisors) date of knowledge to accept or deny a claim. If the claim is reported late, it leaves the adjuster little time to investigate the validity of a claim, which might force them to accept it. If the claim is reported 90 or more days after the date of knowledge, the adjuster has no choice but to accept the claim. The impact of a fraudulent claim can have a significant effect on future workers’ compensation pricing.

5. Reduces litigation – When an injury claim is not reported in a timely manner by the employer, it can make the injured employee feel neglected or disgruntled. Reporting the claim early, showing compassion towards the employee, and keeping the lines of communication open will significantly reduce the likelihood of a litigated claim. Employees need to feel they are going to be taken care of medically and still have a job at the company. Employees are more likely to hire an attorney when they feel uneasy about their job security or they are not receiving proper treatment. When a claim becomes litigated, it typically prolongs the time it takes to close the claim and increases the cost by an average of 30%.

6. Untreated medical only injuries could develop into indemnity claims – A small percentage of medical only claims can turn into indemnity claims as a result of unforeseen complications. For example, if an employee has a small metal shard stuck in their finger and chooses not to receive treatment, the finger could become infected, require surgery, and ultimately cause nerve damage. Had this injury been properly treated from the beginning, it likely would have simply been a first aid claim. Early treatment is key to minimizing indemnity claims.

Quickly reporting claims is simply one risk management strategy to controlling a business’s insurance costs. To discuss this strategy and others please feel free to contact Rancho Mesa Insurance at 619-937-0174.

5 Steps to Avoiding Workers’ Compensation Claim Litigation

Author, Jeremy Hoolihan, CRIS, Janitorial Group Leader, Rancho Mesa Insurance Services, Inc.

Workers’ Compensation claims can cost a company time, money, employee productivity, and morale. Litigation is one of the most costly results of a workers’ compensation claim. Once an employee hires an attorney, the time and money it takes for the claim to close drastically increases.

There are several reasons why an employee will find the need to hire an attorney. Practicing a sound Risk Management Program can dramatically reduce the likelihood of litigation. Here are some ways you can prevent most workers’ compensation claims from ever reaching that point:

1. Acknowledge why employees hire attorneys. The employee/employer relationship is a critical factor in determining if a workers’ compensation claim results in litigation. Employees who feel threatened in some way are more likely to hire an attorney. A few key reasons are:
      a. The employee is concerned they will be fired because of the injury and/or ownership or management doesn’t truly feel the injury was work related.
      b. The employee feels they will face retaliation for reporting the claim.
      c. There is a lack of understanding of the workers’ compensation claim process. For those employees that are faced with a workers’ compensation injury, it can be a very stressful time.
      d. There is a fear the claim will be denied or they will be treated unfairly. Attorneys can prey on vulnerable injured employees. Radio and television ads imply injured employees need their assistance in order to get proper treatment and/or a huge settlement they deserve.
    
2. Keep lines of communication open with your employee. Reassure the employee that he or she will have a job when they are able to return to work. In addition, show some compassion and stay in regular contact with the individual. An employee is far more likely to hire an attorney if they are concerned about losing their job or no longer of value to the company.
    
3. Consider the ramifications before firing an injured employee. Termination of an employee after they have been injured on the job can put the company at risk of a lawsuit (Section 132 claim). In addition, terminating an injured worker could cost the company more in wage loss benefits; an injured employee will continue to draw from the workers’ compensation policy if they are unable to return to work, regardless if the company continues to employ them or not. Often, employees are released to modified duty (Return To Work Program). If an employer can accommodate the work restrictions, the employee’s temporary benefits are reduced or eliminated. This can significantly reduce the total cost of the claim.
    
4. Act before a problem employee becomes injured.  Once an injury has been reported, it becomes extremely risky to discipline or terminate a problem employee.  Address and deal with the employee immediately and be consistent with your documentation.
    
5. Train your supervisors!!!! It is vital that supervisors are trained in reporting and handling claims. They are your first line of defense in preventing claim litigation. Businesses should have a formalized Accident Investigation Program in place. Rancho Mesa provides a Supervisor’s Report of Accident or Near Miss form and a Witness’ Accident Statement form to assist in the investigation process.  In addition to all the formal documentation, there are other key strategies a supervisor can use: 
      a. Do not accuse the injured employee of fraud, even if you know fraud is involved. Supervisors should simply document the facts.  If there is suspicion of fraud, make sure you document any supporting evidence in the report and inform the adjuster.  
      b. Do not negotiate the injured worker’s treatment or return to work schedule.  Leave that determination to the claims adjuster.
      c. Keep in touch.  Instruct the supervisor to check on the injured worker from time to time.  Show some compassion and build trust. Assure the employee that their job is secure.

While there is no surefire way to eliminate litigated claims, by following these five steps you should see results.  With the average litigated claim costing 30% more than a non-litigated claim, the savings over time could be significant.  To discuss implementing this strategy within your company’s Risk Management Program, please contact Rancho Mesa Insurance Services, Inc. at (619) 937-0164.