Workers’ compensation insurance covers the lost wages, medical and rehabilitation costs of employees who sustain work-related injuries or suffer from occupational diseases. When employees sustain such injuries or are diagnosed with occupational diseases, employees can hold the company liable. Therefore, to avoid litigation and protect employees, companies purchase workers’ compensation insurance.
Let’s build up a scenario here. An employee of your organization was trying to fix an electrical circuit at his desk when he got electrocuted. Although he was still breathing, it didn’t seem like he was conscious, so you immediately call an ambulance. The paramedics assured you that he would be okay before they rushed him to the hospital. Now, what do you do?
The US Bureau of Labor Statistics reported that there were 2.8 million nonfatal workplace injuries and illnesses reported by private industry employers in 2018. There were 5,250 fatal injuries in 2018, among which transportation incidents caused 2,080 injuries. So, it is not uncommon for such scenarios to happen in your organization. The main question is: who is responsible for handling the workers’ compensation claims within the organization?
Usually, the responsibility falls on the manager or official who purchased the commercial insurance. In contrast, large corporations have a risk management and safety department that understand how to take care of the workers’ compensation claims. However, companies with an HR department transfer all the responsibilities that ensure employee benefits and work-related laws to the HR personnel. Therefore, if you’re in one of those companies, you may be the one who is responsible for handling the workers’ compensation claims. This article will guide you through the claims process and also give you a few pointers that you must consider while doing so.
1. Evaluate the claim
Just like an adjuster evaluates property damage for insurance claims, you must also evaluate workers’ compensation claims. The evaluation will help determine whether the injury arises out of the course of employment. For many cases, the cause is apparent, like the scenario above. However, some damages or diseases could stem from activities that aren’t work-related. The purpose of the evaluation is also to investigate the root cause of the accident.
2. Call the insurance agent or carrier
Once you determine that the injury or disease is, in fact, work-related, you must immediately get on-call with your organization’s insurance agent or carrier. The company or the insurance agent should be your go-to person during such situations. It is not uncommon for most insurance carriers and agents to be unhospitable during such events. However, the right insurance agent knows that the insurance claims process is an excellent time to provide the best service and, in turn, increase client retention.
So, a phone call with the agent or carrier can give you a good idea of how much of the cost the insurance policy will cover. The agent might be able to provide you with directions to file an insurance claim and send you the requirements and forms. Most carriers put their claim forms online, so you can probably find it easily. The form will ask for some standard information like your company’s name, address, and insurance policy number. So, it’s best to have all the required information ready before you fill the form.
3. Provide support for the injured employee
Your role after an accident is to make sure that an injured employee receives medical care. You will need to provide any accommodations or training required to assist the employee’s return to the workplace. If an employee loses time from work, it means they will be losing wages as well. In this case, they may be eligible for other benefits such as the Family & Medical Leave Act, long-term disability, or may need special accommodations to return to work. For cases of permanent impairment, an administrative law judge will decide the compensation for the employee.
4. Prepare for OSHA investigation
For more severe injuries that are irreversible and cause long-term damage, the Occupational Safety And Health Administration (OSHA) may get involved. The OSHA’s objective is to ensure safe and healthful working conditions for employees. They have set and enforced standards for workplaces for organizations to adhere to. For severe injury or disease cases, the OSHA can investigate your workplace to analyze its safety for other employees.
5. Plan and implement corrective actions
When evaluating the claims, you can even check for similar accidents or trends in the organization. If the same type of injuries is recurring, then it may indicate changes in the workplace to ensure the safety of the employees. In conducting an incident investigation, you must look beyond the immediate causes of a mishap. Most evaluations conclude carelessness or failure to follow a procedure as the cause of an incident. However, there may be underlying causes of the accident that can help you create a plan to prevent future incidents.
The key to properly handling workplace accidents is to remain calm and communicate with concerning parties. Insurance agents will have the most information that you need. With proper coordination, you can focus more on the injured employees and creating a safe environment in the workplace.
Priyadarshani Shrestha is a freelance blogger based in the US. Her expertise lies in content marketing and insurance.