What to Do During the First 24-48 Hours of a Claim

What to Do During the First 24-48 Hours of a Claim

On 18 Aug 2015, in

The BJC workers’ compensation team shares the following tips on what employers should do during the initial hours after an injury occurs:                                                                                                                                                                                                               

  1. Get an employee statement on how they believe their injury, illness or exposure occurred. This must be in “employee's own words." History suggests that the longer removed we are from the initial event, our memory wanes and facts tend to get embellished. This statement should be written and signed by employee.
  2. If medical care is needed, direct the employee to the most appropriate medical care without delay. This does not prejudice you from denying a claim if your investigation bears that out.
  3. Immediately investigate any report of accident to verify work-related causative agents. Moisture on the floor that led to a slip and fall, faulty equipment, inadequate lighting, a bump in the floor are all conditions that should be validated immediately. If possible, have the employee take you to where the injury occurred. Validate any facts and evidence -- or lack thereof. Take pictures of the area. If necessary, make corrective actions immediately to prevent additional accidents.
  4. If witnesses were identified, get their statements. If they contradict claimants’ statements, encourage them to write out a statement and sign it.
  5. Document the reported cause of the accident, illness or exposure. Following a set standard of documentation is in the best interest of employers, employees and injured worker. Correct safety problems and document and discipline any violations of your safety policies that the employee may have committed. This will help prevent future violations but will also validate that you have an enforceable policy.
  6. Get a thorough evaluation of the employee’s medical history, any past illnesses or injuries that may have a bearing on the injury and any past workers’ compensation claims. Make sure your attending physician receives all this information. Currently, HIPAA does not apply to records relating to workers’ compensation claims.
  7. Have the employee identify pain symptoms and severity, preferably with ratable tools such as a pain chart, visual analog scale and/or an Oswestry low back disability scale questionnaire. Your BarnesCare physicians have these available.
  8. Speak to the employee’s supervisor or manager to verify facts and other factors that may complicate the recovery or resolution of the claim.
  9. Identify medical, financial or psychosocial risk factors that could delay a timely recovery.
  10. Share ALL pertinent information, job descriptions and data with the initial attending physician. Without this, the main source of information will be the claimant.
  11. If causation is in question, determine whether a Job Task Analysis should be conducted to identify physical demands of the job and a comparison with accepted scientific and medical guidelines for risk for a work-related musculoskeletal disorder.
  12. Notify your insurance adjuster and the attending physician of your pending investigation and, if applicable, your inclination that the injury may not be work-related. Assure them that any initial medical care will be covered but future care or referrals for care may be denied depending upon the results of your investigation.
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