Workers’ Compensation claims can go south and even become contentious between employees and employers, particularly when injuries are not reported on time, the claims process is not fully understood by employees, and employees don’t feel as though their employer cares about their injury. At Prescient National, we stress the critical importance of reporting a claim immediately or within 24 hours of the injury. In doing so, the employee receives the required medical attention, the employer demonstrates that the employee’s wellbeing is a priority, and a detailed investigation into the incident can begin while the facts are fresh in everyone’s mind. Preventing claims-reporting lags helps control medical expenses, reduces benefit delays, minimizes the time that injured employees are out of work, and averts undue influences on employees that could result in litigation.
Reporting a Claim Immediately
An integral component of the Workers’ Comp claims process is ensuring that both employees and supervisors understand the importance of reporting claims immediately. Employees should advise their supervisor of an injury immediately which should then be promptly reported to the Workers’ Comp carrier. This enables the carrier to reach out to employees to ensure they are getting the proper care they need and explain what they should expect throughout the Workers’ Comp claims process along with the types of benefits to be paid if they will be out of work. The injured employees are also comforted knowing there is a team that cares about them and their injury.
Immediate claims reporting also allows the investigation to begin right away. Post-Accident Drug Testing (PADT) can be performed, witness statements can be taken and, if the claim involves any type of machinery, an adjuster can be dispatched to assess if anything is wrong with it to prevent other accidents.
Timely reporting keeps the claim moving along, including helping to get injured employees back to work by getting them medical care quickly, determining if any light-duty work can be performed as per a physician’s orders and, if so, whether the employer can accommodate the return-to-work plan.
In addition, in some states, if claims are not reported promptly, the employer could be subject to a fine.
Questionable Claims
An early investigation can help detect any red flags and if fraud is involved with the claim. If there is a questionable claim or one of which either the employer and carrier is uncertain, the reporting delay can cause serious time gaps in getting all the information including obtaining a recorded statement by the employee on his or her account of what occurred. Delays can also prompt employees to talk with others, disrupting the communication between the employee and employer and carrier. This can potentially cause the employee to be out of work longer than necessary, hinder the employer’s ability to work as a team to get the employee the medical care needed to return to work, and increase the possibility of litigation.
It’s important that employers report all claims and do not make a judgment call as to whether or not the injury was caused at work. An investigation will help determine the root cause of the injury.
Working with Prescient National
Employees as part of the onboarding process should be trained on what to do if they are injured on the job, including the timely reporting of claims. Injured employees are more likely to hire an attorney if they have a poor understanding of the Workers’ Compensation claims process and minimal or no communication with their employer. At Prescient National, our approach is to work with our insureds to make their employees feel supported throughout the claims process – from the time their claims are reported to getting medical treatment and, ultimately, back on the job.
