The Employer’s Process During Workers’ Compensation Claims

Every employer needs to think of injuries as both avoidable and inevitable. Avoidable, because good safety practices and training can dramatically reduce the likelihood an employee is hurt on the job. But inevitable, because employees are human beings who work in the real world. Because injuries will eventually happen, employers need to understand how workers’ compensation claims are handled, and what the employer’s role is during the process.

A workers’ compensation claim begins when an injury is reported to the employer. The obligation to report an injury or illness typically falls on the employee, who must report the issue by a state-mandated deadline to ensure coverage. After receiving the employee’s report, the employer generally has several specific obligations at the outset of the claims process:

  • Provide the employee with any necessary forms that are required by state law and the workers’ compensation insurer to move the claims process forward.
  • Provide the employee with an explanation of his or her rights and benefits.
  • Explain to the employee his or her options for returning to work, which might include short-term accommodations, light duty, or other adjustments.
  • If applicable, report the injury or illness to state regulators. Note that this requirement may exist even if the employee does not file a claim.
  • Submit any required paperwork directly to the insurer in accordance with state law or the insurer’s requirements.

As a formal matter, many aspects of a workers’ compensation claim are resolved between the insurer and the employee. For example, if the insurer denies the employee’s claim, the employee is responsible for pursuing an appeal. For a variety of reasons, employers should avoid the temptation to disengage with the process. Getting the most value from a workers’ compensation program requires more:

  • Stay in regular contact with the employee. The employer needs to know that the insurer is treating the employee fairly and providing the benefits the employer is paying for. The employer also needs to independently track the employee’s progress. This helps the employer verify the accuracy of the employee’s claim. Better communication also helps the employer craft a return-to-work plan.
  • Study the incident. An accident provides the employer with an opportunity to examine the gaps in its safety practices that allowed the incident to occur. In the course of addressing any potential shortfalls, the employer can engage other employees in the process, simultaneously boosting morale and improving safety.
  • Be prepared to support the employee. It’s no secret that insurers are in the business of denying claims. When an insurer has made the wrong call, the employee likely will ask for help. By standing with its injured employees, an employer protects its reputation and lets other employees know the company is not going to abandon them if they are injured.

Many employers lack the in-house expertise required to handle all the complications of a workers’ compensation claim. Third-party claims administrators and claims advocates can take on most of the process work for the employer. When selecting an administrator, it’s important to find one with industry experience and a good track record of customer service.

Gunnin is dedicated to helping clients get more from their workers’ compensation and risk management programs. Our highly experienced team guides each client through the claims process and will take on the burden of claims management. To learn more about our services, give Gunnin a call today.

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