I am starting a special project, and I am asking for your help.
I attended the IAIABC Spring Forum in Atlanta for a couple days this week before slipping down to San Antonio for the last days of RIMS. My main purpose at IAIABC was to participate as a member of their Disability Management and Return to Work Committee. That body has been quite busy the last couple years developing a paper and follow up “How To” guide for effective Return to Work policies.
As is often the case in these gatherings, something was said during the meeting that spurred a larger idea that I wanted to pursue. One speaker, when talking about the initial draft of one section of the “How To” paper, spoke of the general lack of knowledge of injured workers entering our system. I am no stranger to this concept and speak of it often in my blog and in presentations. However, this speaker mentioned that some companies managing claims could do a better job of helping educate workers to the process of our industry by leaving helpful information on their websites.
Now, we have a lot of injured workers who venture upon our site looking for information. It dawned on me that, while we offer rules, statutes, phone numbers, discussion forums and more here on WorkersCompensation.com, we’ve never offered a simple, non-technical, plain language orientation and instruction sheet for injured workers. In almost twenty years online, we’ve never had a “I’m injured. What do I do?” button on our home page that can link to useful information for those uninitiated in workers’ comp.
Well, that is about to change, and I am making a public request for your input and assistance. Below are my (very initial, hastily written and incomplete) thoughts on what should be included in such an offering. If you have suggestions, additions and other useful thoughts on the subject, I would appreciate your sharing them. You may do so in the comments section below this article, or if you prefer, email them to email@example.com. Be sure to put “What Do I Do” in the subject field if you choose that method.
I’ve Been Injured. What Do I Do?
You’ve been injured on the job. You may still be on the job, or your injury might be preventing you from working at the moment. You may have already filled out a “First Report” or “Notice of Injury.” So, what happens now?
It is important to know that workers’ compensation is different in every state. While there may be similar procedures within workers’ comp, how benefits are paid and medical treatment is provided will depend on either where you live or where the injury took place. The information provided here is intended to explain basic elements of workers’ compensation. It is not intended to act as legal advice in any way.
If you have not yet notified your employer of the injury, you should do so immediately. The longer you wait the more difficult your recovery may be. Additionally, delays in reporting may increase the likelihood that your claim will be investigated and or denied. You should make note of any witnesses that saw the accident, or other people who could support your description of the events that led to your injury.
Your employer cannot fire you for filing a claim and cannot deny you the right to file a claim. If either is the case with your situation, you should notify the state or consult with an attorney about the matter. You may find a list of state workers’ comp agency phone numbers here.
Workers’ compensation in most states is considered a no fault “exclusive remedy” for on the job injuries. That means that in most cases, your employer agrees to provide basic medical and lost wage benefits whether the injury was your fault or not. In exchange for that, you are not able to sue your employer for what is known as tort liability. That includes negligence, pain and suffering, loss of consortium, etc. In most cases, by law, you are restricted to those benefits defined by the state where your accident occurred.
You are entering a complex system with many moving parts. You should be aware that no one will be a better advocate for your healing and recovery than you. Your best course of action in the process you are about to undertake is to be engaged, ask questions, and take ownership in your care.
You will likely be assigned a “claims adjuster” who works for your employer, an insurance company or a “Third Party administrator,” or TPA. A TPA is a firm paid to manage injury incidents such as yours. Claims adjusters in the US generally have very heavy caseloads. It is not unusual for them to have more than 200 “files” (injury cases) on their desk at any single time. That means they may not be able to return your call as quickly as you would like, and it may at times be difficult to communicate with them. If you find that they are simply not responding to your calls, you may want to seek out a supervisor with that company.
During this time, it is also very important to keep in touch with your employer as to what is happening with your injury, especially if you are out of work as a result of it. Employers are sometimes not the best at communicating when you are off the job, so it may be helpful for you to be proactive in this area.
There is a chance that your claim will be denied or be subject to an investigation. This may happen when there were no witnesses to corroborate your claim, or if your condition is the result of a cumulative (over time) soft tissue or “invisible” injury. In some states, the actual laws in place may make an initial denial likely, as insurers are given a set amount of time to either accept or deny a claim. If they are unsure or have questions that may take more investigation, they may simply deny the claim so that they have time to more fully investigate. However, if that occurs, it is your responsibility to appeal the decision, or that investigation will likely not happen. They can reverse that decision when evidence supports it, where under the opposite scenario they cannot refuse a claim once it has been accepted should the evidence prove the injury is not work related.
As mentioned, if your claim is denied you can appeal that decision. You should get a reason for the denial from the insurance carrier. Some states have employees, called Ombudsman, that can assist you with this. In some cases, providing more supporting information (witnesses, etc.) to the adjuster may help. You may also consult with an attorney who specializes in workers’ compensation.
When your claim has been accepted, realize that this may still be a slow and very frustrating process. Simple steps, such as being on time for all doctors’ appointments and clearly communicating information with your adjuster, employer and others may help this process along. Other people, such as Nurse Case Managers and Vocational Specialists, may also be assigned to assist you in recovery.
That is what I’ve pecked out so far. This document should not be long or overly complicated; people generally do not have the attention span to read the equivalence of War and Peace when it comes to their injury.
I will continue working to complete and refine this pending “document” over the next few weeks. In the meantime, if you have a useful suggestion or information you think needs to be included, I am all ears.
Thanks in advance for your feedback.