By Nancy Grover
"For whatever reason, I find there is this natural animosity that develops between employers and employees," said Douglas Feldman, a shareholder with the Milwaukee-based law firm Lindner & Marsack, S.C. "If you can try to avoid that natural animosity, you are going to avoid me."
Feldman was a panelist on the session, The Top Ten Things an Employer Can Do to Mess Up a Work Comp Claim!, at the Risk and Insurance Management Society's recent annual conference. The trio suggested that while some injured workers are out to game the system many are first-time filers and don't understand the process.
"They are genuinely upset," Feldman said. "Give them the benefit of the doubt."
Injured workers may feel alienated, leading them to believe the employer is not concerned with getting them back to work. One company, for example, excluded injured workers from an annual turkey giveaway at holiday season.
"Big mistake," said Allison Hanson, director of sales and marketing for TRIUNE Health Group in Milwaukee. "Pick your battles."
The panelists suggest employers include injured workers as much as possible, such as sharing information about the claim.
"We do a report that goes to the field, including the employee," said Nora Vrakas, director of Risk Management Construction Resources Management in Milwaukee. "It's a no-fault system, so we can admit [if] it's our fault."
Watch for red flags. Ignoring red flags during the investigation of a workplace incident is second on the list of ways employers mess up claims.
With workers increasingly having less access to basic health care coverage, there is more incentive for those with medical conditions to file workers' comp claims, the panelists said. The red flags can signal the existence of comorbid conditions.
"The reason to find red flags is so we can manage the claim better," Vrakas said.
"If you have a gut feeling something is not right, pay more attention and make your concerns known to your claims adjuster," Hanson added.
Don't keep secrets. Failing to provide claim information to the insurance carrier or third-party administrator can result in major problems for employers, especially when a seemingly minor claim takes a turn.
"A lot of large companies are guilty of this," Hanson said. "We've all seen medical-only claims where it's a simple laceration, then it turns into staph infection."
One reason employers fail to notify their carriers of claims is to prevent changes on their experience modifiers. But Hanson says that should not be the primary concern. She also pointed out that many jurisdictions have medical-only discounts, meaning only a small percentage of the money spent on the claim would be factored into the ex-mod.
Be consistent. The decision whether to terminate an injured worker can be challenging for employers. While firing an injured worker may be viewed as retaliation, failing to terminate an employee may also be the wrong action.
"We want to make sure we are acting consistently," Vrakas said. "If something comes up that warrants [the injured worker] would be terminated, we will issue a notice saying they can continue doing light-duty work while they are healing, but once they [have recovered] we will terminate them."
Keep tabs on the claim.
Abandoning a claim after a favorable independent medical exam is another mistake, say the panelists. A claimant who has been denied workers' comp may seek benefits through short- or long-term disability and must stipulate whether the injury was work-related.
If general health coverage won't pay benefits, the claim may go to litigation. The employer still has the option to challenge it, if need be.
Giving the insurance carrier total control of the claim is a mistake. "We need to realize every dollar is our dollar, and we must be involved," Vrakas said. "Unbundling of services the carrier is providing should be considered." She suggests companies include money in their budgets to be involved in the claims process.
Refusing to rehire a workers' comp claimant is not a smart move, Feldman suggests, as it can conflict with the Americans with Disabilities Act and other federal and/or state laws. "That's what makes expensive claims."
Feldman says employers need to make sure supervisors understand the importance of returning claimants to the workplace.
Read more at the WorkersComp Forum homepage.
May 21, 2012
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