Improve Claims Outcomes by Practicing One Key Strategy

When your worker is injured, the top priority is to ensure he or she gets the proper medical attention. Whether that means calling 9-1-1 for an emergency, coordinating an evaluation with an internal/occupational medicine physician, or somewhere in between is dependent upon the severity of the injury.

Employers should notify their workers’ compensation carrier about accidents and injuries as soon as possible. (To understand the pitfalls associated with failing to report claims in a timely manner, see this blog article from November 2018.) Claims departments will open a claim with basic information, but when you supply better or more robust information, they can focus on coordination of medical care and the claims investigation rather than chasing down key parties to the claim.

Therefore, whenever possible, we suggest that you have the injured worker present when completing a first report of injury. This assists with:

1. Accuracy of personal information – Address, cell phone number, alternate phone number, email address, date of birth and Social Security number. In today’s world, everyone has a cell phone and that is the quickest way to connect. When delivering or exchanging necessary documentation, the claims specialist can use email to do so in a timely manner.
2. The injured worker’s version of the accident – It’s important that the claims team is told what the employee said happened. Feel free to include supplemental information from witnesses or other personnel who may have a different version of the accident. Remember that completion of an LS-202 is not an admission of liability.
3. Primary physician information – This is not a field that appears on a first report of injury unless this is the provider giving the initial medical care. However, the injured worker’s primary physician can provide claims specialists can get much of the needed information that can help evaluate claims by learning of pre-existing conditions.
4. Witness information – Does the employee believe that there are witnesses and if so, who are they? If the employer has contact information for these workers, it should be shared.
5. Job history – The claims team will benefit from knowing where the injured worker has previously been employed, especially if the employee has been with the insured for less than one year. Have the employee verify the names of the company(ies) and contact person.
6. Photograph – Many employers keep photographs of their employees. If not, one can be taken. While this could be contentious, it can also be approached delicately by letting the employee know that these are used by the claims team for identification purposes.

In emergency situations, it’s usually not feasible to meet with the employee. We suggest sending the most information available and letting the claims team know that supplemental information is forthcoming.

While all the steps above can be important components of the claims process, don’t take for granted the value of simply sitting down with the employee to discuss their injury and mindset. This can go a long way into showing that you as the employer value them and cares about their well-being. Having the injured worker present when completing the first report of injury is a simple post-accident policy that can help achieve great outcomes.

ABOUT THE AUTHOR

Will Scheffler joined The American Equity Underwriters, Inc. in 1998 and serves as Senior Vice President, Director of Claims. His insurance experience began in 1993 with FARA and continued with the ALMA branch (now AEU) in 1998. He has been a speaker at Loyola Law School’s Annual Longshore Conference, U.S. Department of Labor seminars, and ALMA conferences. Will is licensed as an adjuster in Maine, Alabama, and Louisiana and is a licensed Qualified Manager in California. He serves on the Advisory Board for Loyola’s Annual Longshore Conference. Will received his bachelor’s degree from Louisiana State University and earned the CPCU and AIC designations from The Institutes.