The Basics of Administering a Workers’ Comp Claim

Few workers’ compensation claims are simple. Between reporting obligations and insurance paperwork, someone who lacks a good understanding of the process can get lost and make mistakes. From correctly coding an injury to appropriately supporting an employee’s recovery, claims administration involves many important components. A significant part of the work we do at Gunnin is to help clients manage claims to avoid unnecessary complications that can increase costs and reduce the effectiveness of the business’ insurance program.

Even a business with robust safety practices should plan for workplace injuries. Adopting clear policies and training managers and rank-and-file employees about the employer’s workers’ compensation program is a key component of effective claims administration. If an injury happens but no one is sure how to handle it, deadlines can be missed and important paperwork can be forgotten. Managers, in particular, should be trained to know when coverage applies and have the tools they need to facilitate the processing of claims. The basic features of the administration process include:

1. Internal reporting.

The first step after an injury event should be a report by the injured employee or a supervisor to the individual designated to be the first point of contact. That might be someone in the HR department or a risk management specialist. The designated person should have the training to know how to support the immediate needs of the injured employee, including assisting with getting the employee emergency medical care.

2. Prepare incident reports.

Every workers’ compensation program requires the completion of an initial incident report that describes details about the employee’s injury, such as when and where it happened. These reports are time sensitive and need to be completed with accuracy. A typical program will require several reports:

  • An initial incident report, often completed by the employee or with the employee’s input.
  • A report to the workers’ compensation carrier.
  • Statutory reports, if required by law.

3. Providing coverage information to the employee.

An injured employee will have questions about time-sensitive issues like how to select a doctor, how to get reimbursed for medical expenses, and how short- or long-term disability benefits work.

4. Managing coverage.

A business can rarely afford to let an insurer handle a claim without keeping in close contact with the insurer and the employee over the course of the claim. Insurers typically need additional information from employers to calculate important benefits like wage reimbursement. The employee may also have questions and concerns regarding the coverage process. Staying in the loop is important for ensuring that the insurance program is working well for the business as well as the employee.

5. Making return-to-work decisions.

An important part of claims management is making choices about when the injured employee returns to work, any changes to the employee’s responsibilities, and, in some cases, decisions about whether the employee can continue to work at all. The business needs to stay in close contact with the employee and the insurer throughout this process to ensure that these decisions are handled appropriately.

Gunnin works with temporary staffing firms to source practical, sustainable workers’ compensation coverage and improve risk management practices to achieve best outcomes. Supporting claims administration is a core part of what we do. To learn more about how Gunnin can add value to your firm’s workers’ compensation program, give us a call today.

Contact Gunnin Today

Gunnin’s team is standing by to help businesses find new and better ways to tackle their risk management challenges. Contact us today to find out how we can make your firm’s workers’ compensation program do more.