It’s vital that any worker injury and subsequent workers compensation insurance claim is handled with care to ensure the well-being of the worker and the business. When it comes to more severe injuries and catastrophic claims, the stakes are even higher.
A catastrophic workers comp claim that is mishandled could end up costing millions of dollars. Proper handling ensures the best outcome for the injured employee and his or her family, the employer, and the payers.
The employer’s first step is to ensure that the injured employee receives the right treatment as quickly as possible. There should be a plan in place to handle any workplace injury including catastrophic injuries. The welfare of the injured employee should be paramount at this point.
3 Things to Keep in Mind:
1 - Show Compassion and Build Trust
Any injury can be scary for an injured employee and their family, but a catastrophic injury carries with it many additional fears and stress factors. The injured employee will likely have thoughts about whether or not they’ll be able to work again, how they’ll support their family, and how will the injury affect the rest of their life.
Meanwhile, in addition to worrying about their injured loved one, family members are likely thinking about how they’re going to pay the medical bills, take care of the injured person when they get home, and how they are going to juggle everything – work, kids, etc.
Someone from the company should visit the injured employee in the hospital. This provides a chance to express concern, get and give information, ensure the employee and family understand the process, get a feel for the employee’s attitude, and discover the extent of the injury and the prognosis.
Try to put yourself in their shoes and understand what they might be going through. It’s essential that you show that you care and that you try to build trust with the employee and his or her family. If you want to have the best outcome and help prevent litigation, show them that you are not the enemy, but that you are working with them toward the same goals.
2 - Determine the Cause of the Accident
It’s always vital to determine the cause of an injury, especially in a severe injury. Did a machine malfunction? Was it a lack of training? Is it a guarding issue? The answer to this question will help determine how the claim is handled.
For example, if the injury was caused by a machine malfunctioning, the employer may seek money through subrogation – pursuing a third-party that caused an insurance loss.
3 - Thoroughly Investigate the Injury
The only way to determine a cause is with a thorough investigation that determines what happened, how, when, where, and why. That includes talking to the injured employee, taking witness statements, reviewing video, and examining the site where the injury occurred.
In the case of a catastrophic workers compensation insurance claim, it’s a good idea to think of the site of the injury as a crime scene. Although crime may not have been committed, it’s essential to preserve the scene to help determine the cause.
All evidence surrounding the accident should be preserved until the investigation is complete. That means roping off the area and keeping employees away. Also, regardless of how gruesome the scene may be, do not attempt to clean it up until the claims adjusters and any other professionals have a chance to examine the area.
The claims adjuster will need to bring in additional experts such as a nurse case manager, medical advisor(s), safety experts, and home health experts.
Bottom Line
Mishandling of any workers’ compensation claim is a problem, and those problems are magnified when it comes to catastrophic claims.
Do You Have the Right Workers Comp Insurance Protection?
To learn more about workers compensation insurance, and to make sure you are properly covered, give the experienced independent agents at the American Insuring Group a call at (800) 947-1270 or (610) 775-3848 or find us online. We’ll make sure you’re properly covered, AND we’ll help you get a great price too!
