Why You Need A “First 48” Response to Work Comp Claims

Published on Tue, 05/06/2014 - 18:14
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In A&E’s popular television documentary series The First 48, homicide detectives race against the clock to gather evidence, interview witnesses, and identify a suspect in the crucial first 48 hours of their investigations. If they’re unable to develop substantial leads in that time, the trail can quickly go cold and cases can drag on for weeks, months, or years – and some never get solved.

The first 48 hours of a workers’ compensation claim are also critical.

In fact, what happens in the first 48 hours after an employee gets injured sets the tone for the entire claim. After that, the injured employee and witnesses could forget vital details about the incident, and the employee can be influenced by friends, attorneys, or other employees. Until the insurance adjuster investigates, the employee controls the claim.

How do you take control?

Be proactive by designing your own “First 48” post-injury response procedure. There are plenty of legal reasons to act quickly, but studies have also shown that the quicker you act, the lower your overall claim costs will be – and the better chance you have of keeping a small claim from becoming a big one.

What should your “First 48” response include?

  1. Help the employee get medical attention. Whether it’s administering First Aid or calling 911, your first priority is the welfare of your injured worker. Follow the medical treatment protocol dictated by your state’s workers’ compensation statutes. Typically, if the injury is serious and urgent, the employee can see any doctor he or she chooses. If it’s not urgent, you can refer the employee to a medical provider in your company’s preferred provider network.
  2. Get the paperwork rolling. The Department of Labor requires you to report all workplace injuries and illnesses, so complete the necessary Report of Injury or other forms as required by your state workers’ compensation laws. Also advise your HR department and the treating physician about the claim. Be accurate and objective in your reporting. Even if you question the claim, stick to the facts.
  3. Call your insurance company. The sooner you submit the claim, the sooner the adjuster can put things in motion and conduct the initial three-point contact. The claims adjuster can be an invaluable partner in preserving vital evidence, interviewing witnesses, and keeping the claim on track toward resolution.
  4. Investigate while facts are fresh. Conduct an immediate and thorough investigation of the incident. Gather contact information for key witnesses, take photos and solicit feedback from employees who may have been near the site of the incident. Supply all of the information you gather to the claims examiner assigned to the case. Your job is not to make judgment – it is to ensure that the claims examiner has access to all objective information as quickly as possible.
  5. Discuss return-to-work options. Talk to the employee about work restrictions, company leave policies and procedures, and any transitional work you can make available during their recovery. Help the employee get in the mindset of returning to work right from the start. It’s a good idea to have light duty job descriptions prepared in advance. If possible, contact the employee’s doctor in advance of the first treatment to communicate your desire to provide light duty and fax over the job descriptions so the doctor can evaluate the injured workers’ ability to complete the light duty tasks.

Every day that an injured employee is off work costs you money. Take control of your claims with a proactive post-injury plan. And if you need help crafting your own “First 48” response, talk to the workers’ compensation insurance experts at Heffernan Insurance Brokers.