Understanding The Workers’ Compensation Claim Process

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Employers have many obligations relating to their employees health and welfare.  A good agent will help their clients understand their obligations and responsibilities as they go through a workers’ compensation claim.  The better you understand the claims process, the more effective your workers’ compensation program can be.  The critical issues to manage during the claims process are report of injury, claim investigation, claim management, and early return to work.

Report of injury – Once you have a notice of injury, you must report it to your workers’ compensation insurer.  The report should include the employees name, type of injury, date and time of injury, all parties involved in the accident, how the accident occurred, and any medical treatment received.

Claim investigation – One of the most effective methods of reducing your workers’ compensation cost is to understand how and why accidents happen.  The initial contact should be the same day if possible, or at least within 24 hours of the report of the claim.  Claim investigations can help determine the facts of the accident and help you make changes in your operations or procedures that will prevent further accidents.  The investigations should include interviews with all parties involved as well as any manager or supervisor.  Key questions can include a review of safety procedures being followed, and a review of the employee job duties to determine any mistakes.  You should limit your questions to facts as much as possible.  At this point, you should have a clear understanding of what happened, what was done, and how it was done.

Claim management – Once the claim has been assigned to your insurer, do not forget about it.  Continue your investigation and meet with the injured employee to let them know you are concerned with their health and wellbeing.  You must comply with requests made by the insurance adjuster in order for them to adjust the claim according to State laws.  If the investigation revealed any discrepancies in your safety procedures or policies, make the adjustments necessary to help reduce further accidents.

Early return to work – One of the most important ways to reduce workers ‘compensation costs is to have a return to work program.  This has benefits to the employee as well; getting people back to work is proven to help in the recovery process.  An early return to work program is designed to help the employee return to some form of work-related duties.  The employers will need to have a notice from a doctor stating what specific capabilities the employee has.  There are many kinds of return to work functions including modified duty, light duty, limited duty, or full duty.

  • Full Duty – allows the employee to return to normal activities.
  • Limited duty – an employee can return to the same job but with limitations.
  • Light duty – implies the employee can do only specific light tasks such as office work.
  • Modified duty – the employee can return to work but with specific written duties.

Helping your clients understand how the claims process works can be an invaluable tool in reducing workers’ compensation costs.  By effectively managing these four elements of the claim process you can increase your chances of creating a safe work environment for your employees. Our risk control team can assist you in developing the specific policies and procedures that your clients need.

Workers compensation is a type of insurance coverage that protects your employees in case of injury or disease during the course of employment. For anyone who is classified as an employee, it is required by law to provide them with Workers Compensation Insurancecoverage. Employees can opt out of coverage, but if you do not offer it, you can be fined and could face a Class D felony charge with a mandatory minimum one year prison sentence. Termination of an employee who is injured while working and/or who files a Workers Comp Insurance Claim is also illegal. As a rule, a company with five or more employees is mandated to purchase Denver Workers Compensation Insurance to cover medical expenses, permanent disability, and a portion of the injured employee’s wages.

 

 

 

 

 

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