I hear this a lot from business owners – “My employee was not hurt at work, but now I am paying for it.” Here are a few recommendations to help reduce Workers’ Compensation Insurance Fraud:
1. Make accident reporting a part of your employee handbook. Be sure to emphasize that reporting of an on-the-job injury must occur immediately following an accident/injury.
2. Investigate all claims immediately. If a business does not have a documented process for investigating accidents, there is no way a business is going to uncover a fraudulent claim. Look to your insurance carrier for an accident investigation kit. Here is an example of an accident investigation report from the insurance carrier, IWIF. It contains a section for the employee to fill out, a section for any witnesses, and a section for the supervisor to complete.
3. Send the injured employee to an occupational doctor. If the injured goes to the ER, the ER is going to treat the whole body/person. An occupational doctor will focus only on the injury. Occupational Medical Services is an example of a business in Maryland that has physicians which specialize in occupational medicine.
4. Know your reserve for the claim. Your assigned case manager from your insurance carrier normally is the person who can update you on the reserve. Question the reserve. You can look to your insurance broker to assist you if you are not getting adequate responses.
5. Have a return-to-work program. This most important factor to reduce the amount of loss is to get your employee back to work. By providing light/temporary duty during the healing process you help decrease the amount of the loss. The insurance carrier, The Hartford, has two thorough, on-demand webinars for return-to-work programs: Part 1. The Three B’s of Return-to-Work: Barrier’s, Benefits, and Best Practices, and Part 2. Return to Work – Next Steps.
By just focusing on these five best practices, you can help decrease your workers’ comp. losses and get your employee healed and back to work quickly. It is what you call a win-win.