5 Workers’ Compensation Claims Management Best Practices for Employers

Most business owners understand they need workers’ compensation insurance in case an employee gets injured on the job. However, few know the important role they play in workers’ compensation claims management, so we’ve compiled a list of best practices employers can use to make sure workers are taken care of and claims are handled promptly. Performed correctly, these five best practices can help mitigate the cost of a workplace injury.

1. Develop an Injury Reporting Process

The day an accident happens at work is not the day to try and figure out how to handle it. With all the chaos that can follow a serious incident, you’re much better off having a reporting process in place to reduce the likelihood of missing important steps:

• Set up a safety committee: These people are then in charge of immediate response actions, such as handling first aid, calling 911 if necessary, and making sure other employees are safe.
• Identify the person workers should report injuries to: The easiest choice is probably each employee’s direct supervisor, and if they’re not available, then that person’s supervisor or manager. Larger companies may designate a human resources (HR) person as the contact person. However, especially in small companies, the logical person might be the business owner. The person you appoint to this task can also be responsible for completing an incident report.
• Complete an incident report: If you don’t already have an incident report form, there are plenty of samples online you can use to create one. At a minimum, these reports should include:
  • Date and time of the incident
  • Location of the incident
  • Names and contact details of witnesses and injured employees
  • A brief description of the incident
• Save your incident report: Once completed, the incident report should remain in your files at least until your state’s workers’ compensation statute of limitations is up. That’s usually between one and two years from the date of the injury or the diagnosis of an occupational illness, but some states allow injured workers up to six years to file a claim.

2. Keep Important Information Handy

Workers’ compensation claims management best practices include notifying both your carrier and the appropriate government agencies as quickly as possible. One way to make sure this happens is to have all the key contact information in one place. For most employers, this means you need contact details for:

• The Occupational Safety and Health Administration (OSHA): Employers are required to notify OSHA within eight hours if there is a workplace fatality and within 24 hours if an employee requires hospitalization, amputation, or loses an eye. They can report online or call OSHA’s 24-hour hotline or a regional office.
• Your workers’ compensation insurance carrier: Business insurance carriers generally allow you to file a claim by phone or email, and quite a few have online claim capabilities. Your carrier will most likely need your workers’ compensation policy number and details of the incident when you file.

In addition to contact information, you may want to have key forms available—or at least you want to know where to find them online. Probably the most important of these is the first report of injury. Most states require employers or their insurance carriers to complete this form and return it at the earliest possible date after a workplace injury.

Prompt reporting can save you a lot of headaches as you manage workers’ compensation claims because it allows your carrier to investigate when witnesses have a clear memory of the incident. Moreover, you avoid penalties that can come when you miss deadlines or fail to report injuries.

3. Set Up Incident Investigation Procedures

No one expects you to be a detective, but you do need to find out what happened. Not only does this help you minimize the chance of a similar accident happening again, but one of an employer’s responsibilities in workers’ compensation claims is to report potential fraud.

That said, your intent should be to discover the facts, not to prove fraud. Having a procedure to follow can help this along. Some steps might include:

• Securing the scene: Once the injured employee has been given first aid and can be moved, you want to minimize access to the location. This keeps your other workers safe while also minimizing the chance of someone moving evidence you can use to piece together the event.
• Collecting evidence: You want to record any pertinent physical evidence at the scene of the accident. For example, you want to grab security tapes if you have them. If not, you may want to take photos of the location so that you have a record of slippery floors or broken equipment.
• Interviewing witnesses: Talk to the people who were at the scene to find out what they saw, both at the time of the accident and any events leading up to it. You may want to have a set of prepared questions, such as:
  • What was the worker doing at the time of the accident?
  • What equipment was the worker using?
  • When was the last time the equipment was serviced?
  • Is safety gear required and was it used?
  • When was the last time a supervisor checked this work area?
  • Have you seen similar accidents in this area?

Recording these responses serves two purposes. First, you can use them if you have to file a workers’ compensation claim. More importantly, you want to stop similar accidents from happening, and you can use the information you gather to improve your safety procedures. This has the added benefit of lowering your workers’ compensation insurance costs.

4. Create a Return-to-Work Policy

One of the most important parts of workers’ compensation claims management is getting your injured employee back to work. This is essential to keeping your overall costs down, but it can also boost employee morale after a serious accident, so you want to have a policy in place to ensure everyone involved is on the same page. Your return-to-work policy should address:

• The policy’s purpose and scope: You want to clearly state the goal is to get your employee back to work as soon as possible, and that your return-to-work policy does not take the place of accommodations allowed by the Americans with Disabilities Act (ADA) or the Family and Medical Leave Act (FMLA).
• Eligibility: You most likely want to include any employee who is eligible for workers’ compensation benefits, but you also might want to add employees who take leave for other reasons.
• Transitional work: Your policy should define transitional work and outline any obligations either party has in creating, accepting, or refusing modified work assignments or alternative positions.
• Procedures: Return-to-work plans tend to be tailored to the injured individual, but your policy can outline the general steps. This might include any necessary forms or deadlines for requesting assistance as well as requirements regarding a doctor’s approval.

5. Record Contacts With Key Individuals

Procedures and recordkeeping are crucial to good workers’ compensation claims management. That trend continues with the creation of a contact log where you can record each phone, email, and in-person contact with the people involved in the claim process, such as the injured employee, your claims adjuster, and your employees’ healthcare providers.

The log should include the date, name of the person contacted, and a summary of what was discussed. Some employers may also want to list other details, like the claim number and the employee’s anticipated return-to-work date. The goal, however, is to ensure that people remain in contact throughout the worker’s recovery and to have a written record in case there is ever disagreement on expectations.

Bottom Line

The secret to successful workers’ compensation claims management is planning. Think about what you might need if an accident were to occur and create procedures to address those needs. That way, you can make the claims process go more smoothly for all parties involved.