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April 13, 2020

Best Practices for Workers’ Compensation Claims

managing workers’ comp claims

Workers’ compensation laws are frequently misunderstood as they can vary significantly between states. If an employee reports an injury, and you are unsure of what steps to take, then you are not alone. Regardless of your company’s geographical location, the first two days following an employee injury on the job are critical.

It is important to act promptly for legal reasons, but also because studies have shown the more quickly the workers’ compensation process is initiated post-injury, the lower the overall direct and indirect costs of a claim. In fact, just 48 hours after an incident occurs, injured employees and witnesses have already begun to forget crucial details, and recollections may become skewed by the opinions of outside parties, such as an attorney, or from simply talking to one another.

Based on policy language, coverage forms, and information from workers’ compensation insuring carriers, in most situations exposure and/or contraction of COVID-19 by an employee will likely not be covered under the workers’ compensation policy. Circumstances in which the type of employment places the employee at a substantially greater risk of contracting the disease than the general public would be more likely to result in a covered claim. Possible examples: healthcare providers, laboratory workers, airline & transportation workers, and border protection workers. Legislative actions taken by federal and state authorities may also impact coverage.

Endorsements and/or exclusions to look for when reviewing policies to determine if a claim may be compensable include, but are not limited to:

  • Virus
  • Disease
  • Infections/communicable disease
  • Bacteria
  • Fungi
  • Mold
  • Contamination/contaminated
  • Pandemic

Coverage for COVID-19 will ultimately depend on the specific facts of the claim, the policy language, case law precedents and applicable state laws.

If your employee reports what they believe to be a work-related injury, then you can help protect your company and mitigate claim costs by taking the following steps immediately after an accident / injury / illness is reported to you:

  1. Assist the employee in seeking medical attention.

If the injury is an emergency, seek immediate care for the employee. All state workers’ compensation laws allow the employee to see any doctor in an emergency situation. If the situation is not an emergency, then you should refer to your state specific laws and your workers’ compensation policy on how you can assist your employee in receiving treatment as well as fulfill your responsibilities’ as an employer. Never prevent an employee from seeking medical treatment, even if you believe the injury is not serious or work-related.

  1. Perform an assessment or accident investigation.

Visit the place where the injury occurred and make notes of the surrounding environment. Speak with employees who witnessed the event or who work in close proximity to where the incident occurred. If possible, have witnesses and injured employees write down in their own words a statement of events, and have them sign and the date it.

For all incidents, be thorough and consistent in the type of information gathered as well as how it is gathered. It is critical to begin the investigation within the first 48 hours in order to ensure the details of the accident or injury are fresh in the minds of employees/witnesses.

  1. Take immediate action to prevent any additional accidents or injuries.

After investigating the site, take the necessary steps to make certain the incident will not happen again. Example: For a spill, block off the area in question and determine if other unsafe conditions exist that need to be addressed.

  1. Report the injury / accident / illness.

According to the department of labor, several reports must be generated when an injury occurs in the workplace. Additionally, you must complete the appropriate forms required by your state workers’ compensation law in the required timeframe and follow your company procedures for incident reporting. It is common for businesses to require the incident be reported to the Human Resources department, the employee’s direct supervisor, and the medical provider who saw or treated the employee.

You should also report the injury / accident / illness to your broker and insurer as soon as possible and according to your policy terms. This includes the workers’ compensation claim submission. Your insurance provider could give you valuable information about medical care, make timely payments and begin his own investigation into the incident as necessary.

  1. Inform employees about company policies pertaining to returning to work.

Not only is it crucial to review work restrictions and leave procedures, but it is also imperative that you inform the employee about the possibility of transitional-duty jobs that would suit their needs during the injury recovery period.

In addition to these points, make sure you become familiar with the workers’ compensation laws in your state(s) of operation. Your state’s workers’ compensation board will help you stay in compliance with the legal timelines in effect in your state, which will ultimately help save your company money.

If you have any questions, please contact a member of our team.

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