Avoiding Questionable Worker's Compensation Claims

Following are some basic elements of a good accident response program. These tips came from the suggestions of experienced worker's compensation claims personnel and defense attorneys.

1. Worker's Compesation Policy Statement

Develop a clear and strong policy statement on the importance of promptly reporting all suspected accidents and injuries to supervisors or designated worker's compensation claims representatives. Make it clear that filing false claims is grounds for discharge. Put the statement in work rules and procedure manuals. Make sure all employees know and understand the policy and rules.

2. Knowledgeable Managers

   Make sure that all supervisors know how to handle worker's compensation claims, including:

   • who to send the worker to for completing the report of injury
   • the importance of immediate investigation of the circumstances surrounding the injury including witness reports
   • the supervisor's responsibilities to make sure the employee gets appropriate medical care (see 7 below)


3. Effective Communications

   Poor communication between the employer and the insurer is very often at the root of inappropriate payment of marginal or invalid claims. Train your claims reporting personnel on how to thoroughly document a reported injury. Unfortunately, filling out forms tends to be regarded as menial or undesirable work. As a result, inexperienced people fill them out. Have an experienced person fill in the form and make sure the facts stated in it are accurate.

4. Obtain Accurate Information

   Ask for a statement about the nature of the accident and the injury suffered from the claimant. Let them record the cause and nature of the accident in their own words. Encourage them to be specific. They should sign and date the statement.

5. Establish Preventive Practices

   Reenact accidents — even minor ones — to determine what happened and how the hazard can be avoided in the future. The emphasis of this reenactment should be safety and injury prevention; gathering useful evidence of abuse is just a by-product. If possible, include union representative, safety manager, supervisor, injured worker, and other interested parties. The more visible and "team oriented" the effort, the better.

6. Prompt Reporting

   Promptly report the claim to your carrier along with any suspicious circumstances that may require further investigation. Late reporting of claims increases lost time and medical cost, fosters abusive claims, and increases the probability of expensive litigation.

7. Return to Work Options

   The employer should periodically check with the medical provider to discuss return to work options.

8. Value the Employee

   Stay in touch with your injured employee. Encourage them to stay faithful to prescribed therapy. Encourage employees to keep medical appointments and to be available when you call.

9. Maintain A Safe Work Place

   Make the main purpose of your safety program the prevention of injuries to your workers by the removal of hazards, proper training, and the fostering of a safe work environment.