Workers Comp Claims Gone Bad!

John Smith is injured on the job and reports to a hospital emergency room.  Neither John nor his supervisor report the injury for several days and are non-cooperative when contacted by CBR’s Injury Counselor.  Meanwhile, John sits at home waiting for his injury to heal.  When things don’t go as desired, John hires an attorney.

It’s the perfect storm to wreck your workers comp rates!  (Not to mention, our Injury Counselor’s nightmare!)  In this scenario, at least four crucial things happened that will greatly affect our ability to assist the injured worker:

• • The injured employee did not follow appropriate protocols in seeking treatment.
  • The injury was reported late…or not at all.
  • No Return-to-Work program was enforced.
  • There is now an attorney involved.

Potentially, any one of the four will take a bite out of your bottom line.  Altogether they have the potential to cost your company a lot of money.  Let’s examine each of these factors and their potential impact.

Injury Protocols
CBR has set up specific protocols that enable injured workers to receive the treatment they need in a timely manner, at contracted fees.  Failure to report to the correct medical facility results in greater hardship for the injured employee and greater cost of the claim.  Injured workers should always report to the nearest Concentra Medical Center.

Reporting to an emergency room is especially problematic.  ER costs are often 4-5 times greater than the contracted costs at an occupational medical facility such as Concentra, and they provide poor follow up.  Typically, the injured worker will be referred to a physician who is not on the preferred provider list and who may not be able to get the injured worker in for several weeks.  That is detrimental to the employee’s recovery and extremely costly to the employer.

In addition, hospitals and other providers seldom provide work status and other critical information to our Injury Counselor.  Thus, we are not able to assist the worker.  This prolongs treatment and increases the length of time a worker is off work.

Every employee should know specifically what to do in the event of injury.  CBR has provided Safety Orientation webinars in English and Spanish which should be required viewing for all workers.  Why not use this webinar at your next safety meeting?

Cooperation from Injured Workers and Supervisors
Timely reporting of injuries is crucial in order to assist injured workers and contain costs.  Reports should be provided by the Injured Worker and by the Supervisor. The information that is reported should be complete and as detailed as possible.  Our Injury Counselor routinely follows up with phone calls to injured workers and supervisors.  The more cooperation we receive, the better we are able to assist the worker and contain the costs.

Another beneficial habit is to have injured workers on modified duty schedule therapy and doctor’s appointments at the beginning or the end of the day, rather than mid-day.  This allows the worker maximum time at work (and thus a larger paycheck) and reduces disruption.

Return-to-Work Program
The most costly mistake to the injured worker and to your company is not having a Return-to-Work program.  When a worker is off work due to an injury they will only receive a maximum of 2/3 their normal pay (if they are eligible for compensation of lost wages).  Yet, your company’s rates will be hit especially hard if a worker is off work.  It’s a double whammy that hurts the company and the injured worker.

Thus, CBR is extremely proactive in implementing and enforcing Return-to-Work programs.  There are three keys to a successful Return-to-Work program:

• Consider what tasks an injured worker might be re-assigned to BEFORE an injury occurs.  Check out these Return-to-Work Ideas.
• Think “outside the box.”  Keep in mind that, as an employer, you may assign workers to any task.  If a worker is released to modified duty, but can’t perform their usual task, re-assign them to another task.
• Look to CBR for help!  We are happy to brainstorm and provide ideas to help you keep your workers productive.

Attorney Involvement
As you can well imagine, once an attorney is involved in a workers comp claim, it gets very expensive for the employer.  However, what the attorney doesn’t tell the injured worker is that state laws limit what an injured worker will receive.  Thus, the injured worker will receive only what would have been granted anyway, and the attorney will take a cut of that.  Therefore, it costs the employer more, the injured worker receives less, and the attorney comes out smelling like a rose!

CBR can help avoid litigated claims.  We are here to answer questions that employers or employees have regarding a workers comp claim.  Whether you are the employer or the injured employee, CBR’s Injury Counselor should be your first resource.  We will make sure all claims are handled appropriately so that the best interests of injured workers and employers are preserved.  Contact us any time there is a question regarding a claim.

Be sure to view Workers Comp Claims Gone Bad.
Don’t allow a work comp claim to become your worst nightmare!