MANAGING WORKERS COMPENSATION CLAIMS AND INVESTIGATIONS
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1 MANAGING WORKERS COMPENSATION CLAIMS AND INVESTIGATIONS
2 MANAGING WORKERS COMPENSATION CLAIMS AND INVESTIGATIONS AGENDA: Real Life Scenario Have a Workers Compensation Policy Provide Training to all employees Why Conduct an Investigation The W s of Investigating a Claim Be Proactive Questions
3 DETAILS: REAL LIFE SCENARIO Human Resources receives a call on Monday morning regarding a Workers Compensation claim. Employee injured on the job on Friday Went to ER on Saturday morning Back and Neck injury Leg injury NOW WHAT??????
4 WORKERS COMPENSATION POLICY Workers Compensation Policy: Purpose and Objective Inform the employee of their rights and obligations Employer compliance with State Laws Benefits to all employees who experience an injury or illness that arises out of the course and scope of employment Key components Compensation benefits by applicable law Reporting requirements Posting notices (visible to all employees)
5 WORKERS COMPENSATION POLICY Employee Responsibility Immediately report all work related injuries and accidents Seek medical treatment Stay in touch with Human Resources Provide written update with any restrictions Comply with the company recording, reporting and investigation obligations Be aware of the consequences of reporting a fraudulent claim Manager/Supervisor Responsibility Arrange medical care for the employee (Call 911 for life threating injuries or illnesses) Report the employee accident/injury to Human Resources within a specified time period Complete the Injury and Illness Incident Report (Provide accurate information and any evidence) Allow the employee to file a claim do not take any action to discourage them from filing a claim (Termination)
6 WORKERS COMPENSATION TRAINING
7 WORKERS COMPENSATION TRAINING Key Objectives How to avoid employee injuries Providing a safe work environment (Report any workplace hazards) Personal Protective Equipment (PPE) Reasonable accommodations How to report an injury OSHA Training Safety Management Program Know the State Laws and Requirements Investigations Workers Compensation Fraud is a crime POLICIES CAN T BE IMPACTFUL WHEN EMPLOYEES ARE REMINDED OF THEM
8 WHY INVESTIGATE WORKERS COMPENSATION CLAIM Why conduct an investigation? Fraudulent claim OSHA Investigation Prevent other injuries How the injury occurred what was the employee doing/supposed to be doing Prepare for a possible defense
9 WORKERS COMPENSATION FRAUD (a two-sided monster)
10 WORKERS COMPENSATION FRAUD (a two-sided monster) Employee Fraud No witnesses to the injury Delay in reporting Delay in seeking medical treatment Injury while off work Financial stress at home Filed multiple claims Injury at time of termination Employer Fraud Denial of valid claims Misclassification of workforce Late issuing disability checks Making an example out of employees who have submitted a claim Ghost Policies independent contractors
11 CONDUCTING AN INVESTIGATION OF AN WORKPLACE INJURY How to conduct an investigation? Investigate immediately (Can directly affect the outcome) Secure the area (Making sure it is safe) Treat the injured worker Have the manager complete the first notice of injury (accident report) Speak with the employee and any witnesses Determine if any warnings are appropriate
12 CONDUCTING AN INVESTIGATION OF AN WORKPLACE INJURY THINK W What? What happened? What was the employee doing? What was the employee supposed to be doing? What are the employee injuries? Who? Who was there? To whom was the injury reported to?
13 CONDUCTING AN INVESTIGATION OF AN WORKPLACE INJURY THINK W When? When did the injury happen (date and time)? When did the employee first complain to manager or another person? When did the employee first feel pain? Where? Where did the accident happen? Where was the physical location of the employee? Why? Why did employee wait to report the accident? Why did this happen?
14 CONDUCTING AN INVESTIGATION OF AN WORKPLACE INJURY INVESTIGATING Accident Reconstruction Interview witnesses What were the conditions of the environment? Timely documentation of the injury (details) Get written statements Remain in contact with the employee Surveillance Public records and background checks
15 REAL LIFE SCENARIO
16 REAL LIFE SCENARIO
17 BE PROACTIVE REGARDING A WORKPLACE INJURY HAPPY EMPLOYEES = LESS CLAIMS POST INJURY PROGRAM RETURN TO WORK TREATING THE INJURED WORKER WITH RESPECT making sure they get quality care
18 QUESTIONS? Millions Recovered For Injury Victims. One Call..That s All!
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