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Investigate and manage

A company with a good safety culture utilizes all of the appropriate elements in reducing and eliminating accidents and the associated costs. It also recognize that if an accident occurs then there are necessary steps to help control the cost. Those steps include appropriate reporting and an effective investigation. The accident investigation determines the root cause(s) and paves the way to implement corrective actions to prevent it from happening again.

Should the accident result in an injury, the focus now is on claims management. Claims management includes filing the claim, constant communication with the claims examiner, establishing a designated medical provider program, providing modified duty and communication with the injured worker. Some of these steps are best started before an injury occurs.

Before an injury:

  1. Establish a designated medical provider program. If possible, this should be done and communicated to employees before any injuries occur. A company can select a designated medical provider to treat their employees for work related injuries. Selecting a designated medical provider can assist with communication with the doctor’s office and prompt work restriction information for modified duty. This program should apply to all employees at all times. This should be posted and every employee should know and understand where to seek medical treatment for work related injuries.
  2. Register on the State Insurance Fund website. You can file a first report of injury online without registering, but registering gives you access to your specific information. With this access you can stay updated with the status of claims and policy information. You can view and print claim reports and the Loss Experience Analysis Report, which will show you total losses, loss ratios and other important information.
  3. Assign the role of Coordinator. This is the person within your organization who will coordinate all communication with the injured employee, the claims examiner, and others.

After an injury:

  1. File the claim. A claim must be filed if the injured employee misses a full day of work due to the injury, the employee receives medical treatment, or if they ask you to file. The claim can be electronically filed via the State Insurance Fund’s website. The website includes the First report of Injury which must be completed and submitted to file the claim. Electronically filing is the most efficient way to submit the claim. If preferred, the paper form can be completed and mailed.
  2. Communication with the claims examiner. This is one of the most important steps. The examiner’s name and number should be known. This should be done immediately upon registration of the claim by the State Insurance Fund. Discuss the details of the claim with the examiner. Inform the examiner of any concerns or disputes. Inform the examiner if there are issues that need to be investigated. Confirm all of the important information such as accident details, medical treatment, wage, company policies, whether modified duty is available and when. The communication with the examiner does not end with this initial consultation. Communication should be frequent throughout the life of the claim. Inform the examiner of any changes, surprises, return to work dates, payroll information, etc.
  3. Provide modified duty . Providing modified duty is one of the very best ways to controlling the cost of the claim. It is recommended that modified duty be provided within 5 calendar days of the accident. However, if this is not possible, modified duty can be provided at any time during the claim. What can be offered as modified duty depends on the medical documentation provided by the treating physician. Modified duty should be thought of, and described as, transitional duty. Transitional duty should have a definite start date and a definite date to re-evaluate.

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The material presented on this website is provided only as a general information guide and is not intended as legal advice.