There are several contributing factors that can help shape the positive outcome of a Workers’ Compensation claim and the costs involved – from the initial reporting of an injury to continued communication with an injured worker, post-accident drug testing, ongoing interaction with the adjuster on the case, and an effective, early Return-to-Work program. Employers have the ability to control their costs and, ultimately, any out-of-pocket expenses (deductibles, retentions) and premiums paid by helping to advance the Workers’ Compensation process and return the claim to pre-injury status. The value of being an active policyholder cannot be understated. Let’s take a look at how these factors can make a difference in the outcome of Workers’ Comp claims.
First Report of Injury
Ensure injuries are reported immediately to the carrier with accurate, critical information (such as flagging serious injuries) – optimally within 24 hours of the injury or accident. The sooner an injury is reported, the sooner a medical assessment can be made available and the sooner an employee is on the right track to recovery. A delay in reporting may impact an employee’s medical treatment, possibly aggravating the injury, extending the pain or discomfort, and delaying a return to work. The delay can also affect the overall expense of medical treatment and the cost of the Workers’ Comp claim. Just take a look at these statistics (2018) from the National Council of Compensation Insurance (NCCI):
- 2-week reporting lag time: Claims are 18% higher than those reported the same day as the injury
- 3-week reporting lag time: Claims are 29% higher than those reported the same day as the injury
- 5-week reporting lag time: Claims are 45% higher than those reported the same day as the injury
For example, a two-week reporting lag time will increase Workers’ Compensation indemnity costs by an average of $76,700, while a five-week delay results in a $94,250 increase in the indemnity portion of the claim.
Communication with the Injured Worker
It is crucial that communication is established between the injured worker, the doctor, the claims adjuster, the supervisor, and insurance agent to help ensure the employee can get back to work as soon as possible. If this isn’t done correctly, it will directly impact the cost of the claim and the organization’s bottom line. Provide the injured worker with information that reviews the entire claims process, what he or she should expect, and the employer’s return-to-work policies. This helps reduce any possible frustration with the employer, the physician, the injured worker, or the claims process. It also helps develop trust and shows the employee that the employer cares and is committed to quickly resolving work-related claims.
An ongoing proactive outreach program and overall advocacy approach on behalf of management while the employee is recovering also goes a long way in demonstrating that his or her wellbeing is a company priority.Research by the Workers Compensation Research Institute indicates that an employee’s feelings about the relationship with his or her employer after an injury may drive outcomes related to the claim. Workers who feel anxious about being fired after an injury, for example, experience poorer return-to-work outcomes than employees without such concerns.
Post-Accident Drug Testing on Workers’ Comp Claims
According to the U.S. Department of Labor, drug and alcohol use at work may contribute to 65% of on-the-job accidents. Substance abuse contributes to 38%-50% of Workers’ Compensation claims. To help determine whether drug or alcohol use contributed to a workplace injury, under OSHA guidelines, an organization may implement post-accident drug testing following a workplace-related injury or accident in accordance with their post-accident drug testing policy. Employees should always be made aware of company policies regarding drug testing.
A 12-panel post-accident drug test should be conducted within 12 hours of the accident. The testing can offer peace of mind that company safety policies or other employees were not at fault for certain accidents. In addition, in conducting post-accident drug testing, employers are able to better understand the cause of an accident and implement additional loss-control measures in their safety programs. This will ultimately help reduce workplace injuries and improve an organization’s loss history.
Ongoing Interaction with Claims Adjuster
A proactive adjuster will coordinate and manage an employee’s medical care and return to work, therefore, it’s important for an employer to follow up and remain in constant communication with the adjuster. Open communication encourages and enables an exchange of information between the employer and adjuster about the claim and collaboration on assisting the injured employee while moving the claim forward. Again, the sooner a claim is resolved and an employee is back to work, the lower the associated claim costs.
Good rapport between the adjuster and injured employee early on in the process is also key in improving a claim’s outcome. A positive relationship with the adjuster will help reduce the probability of future attorney involvement. The adjuster will also be better able to identify any compensability issues and make timely payment of benefits. With severe injuries, early employee contact will help with immediate medical management.
Implementing a Robust Return-to-Work Program
The longer employees are out of work, the harder it becomes to get them back into the work routine. Expediting their recovery through the use of an early Return-to-Work Program that includes a modified-duty plan gets employees back on the job sooner, keeps them active and reminds them that they’re part of the team. Modified duty is a transitional role that safely accommodates an employee’s injury and follows his or her treating physician’s instructions. It is among the most important tools an employer has in its arsenal to reduce lost time and costs. Medical-only claims are reduced by 70% when calculating an employer’s experience modification factor. This is why Return-to-Work programs are so important and why it is imperative that management plays a key role in initiating a successful program.
About Prescient National
Workers’ Compensation specialist Prescient National is all about knowing what’s coming around the corner. Our approach involves foreseeing, planning, and executing perfectly because, through anticipating legal trends, sensing market shifts, and understanding how projected economic cycles impact Workers’ Compensation, we have an informed vision for the future – these are the key drivers we deliver in our products, programs and risk management strategies. Prescient National offers solutions to employers based on their individual needs, risk-taking appetite and loss history: guaranteed cost policies, small-, mid-size, and large-deductible policies, retrospective rating policies, excess/self-insurance and captive options.
