CLAIMS MANAGEMENT limited to the following :
1 . Injury did not arise out of , or in the course and scope of , employment
2 . Injury was caused by prohibitive acts
3 . Injury was due to intoxication 4 . Injury was self-inflicted 5 . Injury was from horseplay
6 . Injury occurred during lunch or a break
7 . Injury was due to employment deviations
AN EMPLOYER ’ S DOCUMENTATION IS CRUCIAL TO THE CLAIMS ADJUSTER ’ S ABILITY TO DENY PRIMARY LIABILITY .
Under Minnesota law , the claims adjuster has fourteen days to admit or deny a workers ’ compensation claim . Assuming the average claims adjuster is handling over one hundred active files , you can see how the adjuster does not have a great deal of time to do an extensive investigation of every workers ’ compensation claim that comes in . By assisting the claims adjuster in the initial investigation of the claim , the employer ’ s efforts may be the difference in whether the adjuster accepts liability for a claim that could cost the employer tens of thousands of dollars versus denying liability that ultimately could result in a resolution that may be only 15 – 20 percent of the full value of the claim .
To help employers with their investigation of workers ’ compensation claims , we would recommend that they establish company procedures so that they are consistent in their reporting and management of these claims . These procedures should include the following :
1 . Use an incident report . Too many times , the employee ’ s symptoms and body parts involved seem to change over time . By having the employee document at the onset what and where symptoms are , the employee will lose credibility if his or her symptoms expand to other body parts at a later date .
2 . If the injury is reported to another employee , such as a supervisor or company nurse , require that person to document everything that was reported , even if the employee does not want to file an injury .
3 . Provide all documentation to the claims adjuster when filing the First Report of Injury and communicate with the claims adjuster right away concerning any suspicion of fraud or inconsistencies in the employee ’ s story that you are aware of .
Finally , there are certain things an employer should never do when an employee reports a work injury :
1 . Never offer to pay for the claim yourself . You have workers ’ compensation coverage for a reason . It is illegal not to provide workers ’ compensation coverage for your employees . It is also illegal to try to circumvent the workers ’ compensation system by either intimidating the employee to not report the claim or by paying for bills to avoid reporting a claim . Once it is discovered in a litigated case that an employer has done that , it all but ensures the employee will prevail on the claim as the employer has lost all credibility with any judge who will be hearing the case .
2 . Do not treat one employee different from another in how you handle the investigation of a reported work injury . Too many times , an employer may think it knows an employee , but it turns out that the employee who is also a fishing buddy is a different person when injured on the job . Often , this person is not looking out for the employer ’ s best interest when it comes to bringing a claim . Since you ’ re running a business , you must stay consistent in how you handle your employees in all aspects , but particularly in reporting and managing work injuries .
3 . Understand that most work-related injuries are legitimate injuries . As much as we have become cynical over the years , from a practical standpoint , it is more likely that the injury reported is legitimate and that the physical complaints are real . The employee may need medical care and treatment , may likely need time off from work , or may need to work with restrictions for a period of time .
4 . Work injuries are a huge inconvenience for both the employee and the employer . It is important for the employer to install a level of patience in assisting the employee to get back to work as soon as possible . The sooner the employee returns to work , the cheaper the claim ultimately is .
An employer ’ s efforts to investigate a claim right away is the key to every workers ’ compensation claim . The more you can document the details of a claim , the more likely you are to keep your workers ’ compensation expenses down in the long run . +
BY : GREGORY BROOS
This article was written by Gregory R . Broos , a Senior Shareholder with Brown & Carlson , P . A ., the largest Workers Compensation Defense Law Firm in the State of Minnesota . Mr . Broos has represented Self-Insured employers , Insurance Companies and Third Party Administrators in Minnesota and Wisconsin for almost 25 years . If you have any questions , he can be reached at : ( 763 ) 253-0152 or gbroos @ brownandcarlson . com .
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