Incidents & Claims

Guiding Your Clients Through Workers Compensation Claims

Do you know the true cost of inaction? It’s more than you think.

Your client’s costs can increase by 51% if they do not report a workers compensation injury in good time. For even the largest of companies, this can be a devastating mistake. 

The increased claim cost demonstrates the importance of having a defined process of reporting and managing claims. The process protects workers, customers, and the company by helping employees deal with injury and get back to work healthy. 

As their broker, you can guide clients through the logistical details of workers comp claims. And trust us, the details are essential. 

Expect Unexpected Incidents

The most crucial step happens before an accident takes place. It’s the time your client sets aside to educate their managers and employees on what to do when an injury occurs. They need to understand who to contact and how to assess the situation. 

The company guide to handling a workers comp claim should be included in their safety management plan.  If your client does not have a plan in place, help them develop one. Every employee needs to understand the steps to take after an accident to ensure the process runs smoothly. 

Streamline Incident Response  

When an injury occurs, employees need to notify the appropriate designee in their company. The designated person may be HR, a safety team, or a supervisor. Workers must determine if first aid or more serious medical care is required and whether to notify an employees’ emergency contact. If there’s a risk of other injuries, the workspace needs to be vacated until it is safe for others. 

Your role as a broker is to begin working with your client’s carrier once you learn of an incident. 

The carrier needs to be notified within 24 hours so they can begin the claims process. Keep in mind that the carrier will want to speak with employees who have first-hand knowledge of the incident as soon as possible. After all, memories often lapse or details disappear even after a short time.

There is often a tiny window of time to report an accident; some states require a claim in as few as seven days. The length of time it takes to initiate the process will have a very real impact on the claim’s cost. You can save your client money by advising them through the process. 

Build and Use Your Relationships 

If you’re reading this, then you are an insurance nerd — it’s okay, so am I. A claim is a perfect opportunity for you to help your client by using your knowledge and relationships. 

The workers comp process is very stressful. You can mitigate much of this work by speaking directly with the carrier. You’ll be able to sort through much of the insurance language that your client will not understand. 

Knowing the right people can play an outsized role in a workers comp claim. Having a relationship with a physician will allow your client to send employees to receive treatment right away. A medical expert who understands the business and the types of typical injuries can make the experience much better for the company and employees. It will reduce potential high costs associated with going to walk-in clinics or other physician’s offices. 

However, if there is an emergency, the employee should always go to the closest available treatment center. 

In some circumstances, it may be beneficial for your client to hire a workers compensation attorney. Have a list of firms you know and trust that can represent your client. If an employee sues or seeks additional funds, your client will need good representation to make sure they manage the situation correctly and follow state law. 

Complete the Injury Report 

If your client doesn’t have their own accident/near miss form, they need one. Depending on the carrier or state’s requirements, the injured employee may need to complete this, or a representative from the company will have to meet with them to fill it out. 

If the employee is hospitalized or at home, you can visit and gather details the carrier will need. A face-to-face prevents a back and forth conversation where the provider must try to piece together what happened with limited context. 

After this is submitted, the claim can begin, and more importantly, the employee can look forward to benefits to replace lost wages. 

Assist with the Investigation 

Each workers compensation incident requires an investigation to determine its validity. Fraudulent claims rarely get approved, but when they are, they tend to be very expensive. Statistics show that fraud in workers comp costs roughly $30 billion annually. 

As a third party, you can help your client assess what happened and discuss the details with those who witnessed the injury. 

Mine the Details with the Insured and Carrier 

While the claim progresses, you’ll want to stay in regular contact with the carrier. Work closely with your client’s designee (HR, safety, etc.). If the carrier needs to speak with an employee or supervisor, arrange these conversations. 

Ensure your client tracks details like the time and date of the incident and the number of days lost. This information will determine the amount of money paid for the benefit. 

Offer Advice on the Return to Work Plan 

It’s beneficial for the client and employee to develop a return to work plan. Even if it’s a light-duty role, it prevents your client from hiring someone temporarily and investing time and money to train them, and it reduces the cost of a claim by helping employees get back to work sooner. 

Partner with your client and the other professionals involved to develop a well-documented return to work plan. Many potential factors can affect how and when an employee can come back to the job. A doctor may recommend the employee work only on restricted assignments. 

You may need to have a conversation with your client about the Family and Medical Leave Act (FMLA) and how the law can impact their return to work plan. If the employee is eligible and elects FMLA leave, the employer cannot penalize them for choosing this option. They can, however, restrict their access to workers compensation benefits.   

There may come a time when your clients will want to discuss termination options. It’s important to include input from legal professionals early in these discussions. The Americans with Disabilities Act (ADA) and some state laws prevent the termination of employees who are absent due to a work-related injury except in limited, defined circumstances

Identify Points of Exposure in Coverage

Looking for blind spots in your client’s coverage can protect your clients. As workers comp has changed over the years, they may face exposure to additional costs. In some cases, employees can sue using intentional tort, which places the blame for an injury on the employer, citing the action that leads to the incident was deliberate or intentional. 

Most workers compensation policies and general liability exclude intentional acts. If a situation like this goes to trial, your client may not have the policy to cover defense costs.

Prepare Your Client for New Types of Claims 

Stressful periods cause many employers to see an uptick in mental illness-related workers compensation claims. Between a pandemic and turbulent economic and cultural events, employees have a lot on their plate. They may fear job loss or a furlough. Budget cuts to cope with turbulence may also mean they may have increased job responsibilities without increased benefits or pay. 

If the stress becomes too much, they may file a workers compensation claim for lost time due to stress. The regulations and parameters around such claims vary by state. Many times an employee will have to identify a specific event that leads to mental illness. 

Streamline the Claims Process 

The workers compensation process is messy. There’s a lot of paperwork and many interested parties who each have their own agenda. One thing is simple: your responsibility to provide the best service possible to your client beyond the written policy.

The claims process is a top way to maximize your impact. Add in the right carrier and technology, and you’re on your way to tackling complex problems with ease and freeing up time for new business.

Foresight employs risk management technology to reward employers for good safety practices with lower premiums. A stronger risk management program translates to improved safety and fewer claims.

You can be the one who offers the advice and direction to get them through a claim. Reference our appetite guide to see if your clients are the right fit for Foresight. 

Author: Foresight

We’re a team of compliance, safety, and commercial insurance professionals transforming workers compensation. We write about technology, trends, regulations, and value-adding services.