How To Implement An Prompt Response Program For Your Workers Compensation Clams – Strategy 5
Promptly Report The Injury To The Adjuster
Another major action that should be taken in the first 48-hours is the prompt reporting of the worker injury to the claim adjuster. Delays here can dramatically increase the total cost of worker injuries. According to one major insurance company, these costs start almost immediately and increase over time. For example, if the claim is reported 2-10 days after the injury the final cost increases by approximately 11%. If the claim is reported after 30 days the cost increases by over 55%.
Another study revealed that the rate of litigation increased as claim reporting delays increased. For example, if the claim is reported 2-10 days after the injury the number of claims that involved an attorney increased by 20%. If the claim is reported after 30 days the number of litigated claims increased by 45%. This stands to reason because the injured employee generally feels insecure and is threatened by a process that has not been adequately explained to them. The message should be clear – prompt reporting of the worker injuries equals cost savings to the organization.
Also, if your organization doubts the compensability of the injury it should report the claim to adjuster immediately. They can provide invaluable help here. The organization will also be avoiding friction with the adjuster over the claim because of late reporting. The Claim Coordinator should explain the reasons why he or she feels the claim is questionable. The Claim Coordinator should not file the basic claim information and assume that the adjuster will also conclude that the claim is questionable. Also, the Claim Coordinator should make a recommendation as to how he or she wishes to see the claim handled.
If the injury is serious (however you wish to define “serious”) contact the insurance adjuster immediately. They will want to get involved with the process the first day of injury and possibly involve other resources to help in the claim management process. These resources may include an occupational nurse, rehabilitation specialists, and loss prevention engineering support.
If the claim has fraudulent characteristics, contact the claim adjuster immediately and explain all the facts as you know them and the concerns that you may have.
As part of the initial reporting to the claim adjuster the Claim Coordinator should provide copies of all documents gathered so far, including medical information, initial temporary duty assessment, incident investigation report, employee injury report, and witness statements. The more information the Claim Coordinator can provide to the claim adjuster the better. It is in both party’s interest to be on the same page from day one.
CompEraser comes with on-line, on-demand resources needed to design and implement an effective PROMPT INJURY RESPONSE system, including this important step in the process. Resources also include the formalization of your safety team, injury prevention, OSHA compliance, safety training, workers compensation disability management, plus more. These resources are available 24/7 and used irrespective of which workers compensation carrier you select. Its patent-pending technology also provides unique financial reports for monitoring the effectiveness of your safety and health program on an on-going basis. For more information visit our website at www.CompEraser.com.
