One workers’ comp claim can send your experience modifier (X-Mod) spiraling out of control if the injured employee stays away from work for an extended period of time. The longer they are off work, the more costly the claim becomes since they are receiving temporary disability payments, which can cost up to $1,074.64 per week in California.
All of that adds to the cost of your claim, in addition to any medical expenses that are incurred.
The bane of employers in the workers’ comp arena is open claims and it’s to your benefit to work with the doctor and the insurance company claims adjuster to get the claim closed as soon as is feasible, and safe for the injured worker.
That said, there are ways to reduce the time a claim is open, including:
• Require all employees to report accidents immediately, no matter how minor. While some injuries require just first aid that can be taken care of using in-house medical supplies (which you should have on hand as per Cal/OSHA requirements), others are more serious. If you are unsure whether first aid can fix the problem, it’s best to send the worker to a doctor.
• As soon as an accident is reported, you should move to investigate to determine exactly what happened. You will need to identify witnesses and separate them and interview them one at a time to fully understand the whole story, and also to ensure there are no drastically conflicting accounts.
• You should sit down with the employee and explain the workers’ comp process, and also file the necessary claim forms. Answer the employee’s inquiries quickly and efficiently, preferably designating one person as the primary contact.
• Ask one of your supervisors or managers to accompany the injured worker to the industrial clinic you have pre-chosen. There are good reasons for doing this, including:
1. We have heard of attorneys soliciting employees going into and out of industrial clinics.
2. You gain useful feedback from your supervisor regarding the length of time it takes to be seen and how clean and sanitary the clinic is. This is important because the main reason employees get attorneys is the perception that the employer does not care about them. A filthy clinic with long wait times does not send a good message to your employees.
• Another reason that injured workers get an attorney is that they feel abandoned by their employer, and the longer they stay away from work the more disaffected they may become. For this reason, you need to stay in contact with the employee. Assign someone, preferably the supervisor, to call or visit with the employee on a regular basis to keep them motivated to return to work and to answer any questions they have.
Positive, encouraging messages of the employee’s value to the company are often the best medicine. It helps also if they know their co-workers are hoping for a speedy recovery and their return.
• Identify and establish relationships with doctors who have expertise in occupational medicine and understand the value of returning injured employees to work.
• If you don’t have a return-to-work program in place, you should initiate one. If the injured worker’s treating physician clears the employee for a return to work or for light duty with restrictions, make sure the worker, their supervisor and fellow employee understand the restrictions.
This is important because one of the main factors in workers re-injuring themselves is that their supervisor fails to educate others about the work restrictions and, unknowingly, peers place pressure on the injured employee to perform tasks beyond the restrictions.
• Monitor claims progress if your insurance agent is not already doing so. Discuss the claims with the medical provider and your agent to determine how to get the claim on track.
• Know your claims. Examining your claims, patterns may emerge that identify areas in need of attention.
• Close claims promptly. Open claim reserves affect the X-Mod in the same way as actual claims paid. In some cases, claims that are closed may be on the books as open or the reserves set for the claim may be excessive based on your knowledge of the claim. Your agent should be monitoring these claims and reserves to ensure they are as low as possible, or are removed if the claim is closed.