It was another Claims Management session at RIMS 2012 last week in Philadelphia, and the three presenters were reviewing their top ten ways you can screw up your claim. The session, aptly titled “The Top Ten Things an Employer Can Do to Mess Up a Workers' Compensation Claim”, featured Attorney Doug Feldman of Lindner & Marsack, S.C., Allison Hanson, of TRIUNE Health Group, and Nora Vrakas of Construction Resources Management, Inc.

The three pegged the following as the Top Ten ways to foul things up:

1. Leaving the employee out of the internal investigation and reporting process!
The upfront investigation information is the most critical part of your claim management process. Many employers miss critical information by not involving the employee from the outset. Vrakas indicated it is important to do this, even if the employee must be brought in later to provide information and feedback.

2. Conversely, ignoring the red flags that may arise during the investigation process
Monday morning injuries, late reports, inconsistencies in the employee's story or any other items that should be apparent are important to note. Pre-existing conditions that might have been disclosed earlier and co-morbidity issues are other areas that should be scrutinized. Important to note – red flags should not be used to simply deny claims; rather they should be used to make sure the claim is being managed properly.

3. Alienating the injured worker / keeping them “in the dark”
Managers and injured workers can develop, according to Feldman, a “natural animosity” towards each other, and often that interferes with critical relations necessary to keep the claim moving forward in a positive manner. Many companies stop communicating with the injured worker, or otherwise write them off. That, according to Hanson, is a huge mistake. This point brought about the biggest laugh, when Hanson discussed an employer she had worked with who always gave their employees frozen turkeys at Thanksgiving. It had become an annual ritual that employees greatly looked forward to. It was quite simply, a “big deal”. The employer called her one day to review a couple employees out on workers' comp, and indicated that they didn't think they should give them a turkey this year, since they were not currently at work. Her response was classic; “Are you kidding me? You can't do that! Give them their flippin' turkey!” There could be no greater alienation than to deny someone a special, relatively inexpensive perk simply because they were injured. The negative connotations of that action would likely cost the employer far more in the long run.

4. Failing to file the workers’ comp claim with your carrier or TPA 
Employers, big and small, sometimes fail to properly report an accident. They may not think it amounts to much, or think they can more easily (cheaply) take care of it “under the table”. This is often a costly mistake.

5. Not accommodating light duty
While all employers might not agree, the panel clearly felt that getting an employee back to work in any capacity was better than leaving them at home, where idle thoughts can unduly influence the injured worker. Despite a plethora of studies that show these programs benefit both employer and employee, and the employee actually heals faster, this is an issue that continues to confound cases.

6. Either terminating or not terminating an employee
Obviously an employer cannot terminate an employee because of a claim. Vrakas discussed the need for a consistent termination policy that crosses all spectrums and requirements fairly and evenly. She also discussed that employers can have a conflicting strategy to “never terminate an employee while they are in the healing period”, because it gives employers much greater control over the situation. In the event a worker in that status does something to warrant immediate termination, they would be advised of that they would be allowed to remain in position until the healing period is completed, when their termination would become effective.

7. Abandoning a claim after a favorable IME
Apparently many employers want to file a claim away, believing it to be done at this point. Panel says: “Big mistake”.

8. From soup to nuts: letting your carrier handle the entire claim
While your carrier or TPA might be doing a competent job, the panel reminded us that this is your money on the line, and an employer needs to be actively engaged in the claims management process.

9. Refusing to rehire a claimant 
Many pitfalls exist in this area. Items to be considered include ADA and state employment laws. Feldman indicated that making a reasonable accommodation and rehiring a claimant can often allow an employer to avoid the pitfalls that would exist if they otherwise choose not to.

10. Having an unrealistic expectation regarding the ultimate disposition of the claim
Hanson indicated that surveillance is a prime example of where this point can apply. An employer may look at a “snapshot in time” from an incomplete video and assume they have a much stronger case than they do. Feldman urged employers to be realistic. He said it is called “workers' compensation” and not “employer's compensation” for a reason. It is stilted in favor of the injured workers, and employers need to be engaged and have realistic expectations when managing their claims.

Bottom line, employers need to be involved, aware and engaged in their claim management process. Ask probing questions, gather all the critical data, and treat people openly and fairly through the process.

And above all, if you are known for giving your employees the bird, give that injured worker the bird as well.

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