Nothing upsets a business owner or manager more than paying for and managing the fallout from a suspect workers’ compensation injury. Here are a few but, certainly not all, ways employers can help prevent a fraudulent claim and avoid allowing employees to extend their time away from work once injured.
- Many fraudulent injuries slip through the cracks because they’re reported as a “medical only” injury. Some insurance companies don’t contact workers when they don’t lose time from work and this can set the stage for problems. Malingering can occur when an employee thinks, “Hey, no one is paying any attention to me.” Insist your carrier completes “three-point contact” on all your injuries, whether a lost-time claim or a medical-only report. The adjuster should talk to the employee and a supervisor, as well as review the medical report from the treating physician. Three-point contact serves as a reminder, subtly telling the employee, and potential future claimants, that someone is watching.
- During contact, the adjuster should explain the process to the employee and check the injury details with the employer. Supervisor contact is critical since the supervisor knows the details of the injury as well as the employee’s work history. For example, if the injured worker is having performance problems, the adjuster should more closely monitor the injury. Performance issues at work often mean a greater likelihood the claim will be difficult to settle.
- Communicate frequently with your insurance carrier and adjuster throughout the life of the claim, because circumstances change. A valued employee can experience problems or may require job modifications as he or she heals. Request the same team of adjusters handle all your organization’s claims and get to know your adjusters. This will help prevent communication breakdowns, which can greatly delay claim resolution.Utilize your other employees and maintain a healthy skepticism. Coworkers often know when the injured employee is working or playing outside his or her physical restrictions. Surveillance teams may locate injured employees playing sports, hunting or spending hours at a casino. Often, these tips come from employees tired of compensating for their coworker’s extended absence. Managing malingering sends all employees the message that you will not tolerate deception.
- Remaining in the workforce helps injured employees work in some capacity as they heal. When injured employees stay home, they often become depressed, which can delay healing. Speedy return to work also prevents workers’ comp from being seen as a vacation.
- With stalled or serious injuries, insist on nurse case management. A nurse case manager will help oversee medical care and improve communication between all parties. Strong nursing saves a great deal of money and frustration. When needed, a vocational rehabilitation specialist can help get claims resolved, as well.
Above all, managers should set a tone among injured employees that says, “We care about your injury, and we want you back at work now.” Only with proactive communication will your injury claims stay on track on the path to resolution.
If you would like to discuss your workers compensation claims process or need help with claims management, please feel free to contact me at 732.395.4251 or asica@thealsgroup.com.
