Checklist - Worker's Compensation Claims

Copyright Envision Corporation. 2002. All rights reserved.
Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.
Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/. Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.
Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States and Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" AU!(.A! CA""' *E SUE% $ A C(U&! (, "A/.
CHECKLIST HANDLING WORKERS COMPENSATION CLAIMS
!he initial period is critical in handling wor0ers1 co2pensation clai2s. So yo3 23st be s3re to4
Immediately
Ad2inister first aid Acco2pany in53red wor0er to a selected 2edical provider &eport incident within co2pany $otify fa2ily Assign responsible person to follow clai2
First day
&eport to clai2 handler o3tside co2pany 6ins3rance co2pany or third7party ad2inistrator8 %eter2ine+ on a preli2inary basis+ whether the in53ry is covered by wor0ers1 co2pensation Co3nsel e2ployee and9or fa2ily on clai2s proced3res+ available benefits+ co2pany1s contin3ing
interest in e2ployee1s welfare+ etc. ,ollow 3p with the e2ployee or fa2ily
First wee
Coordinate pay2ent of initial benefits
Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.
!al0 to treating physician to learn diagnosis and treat2ent plan Eval3ate whether 2edical rehabilitation is necessary or appropriate %evelop ret3rn7to7wor0 plan Contact the in53red e2ployee and9or the fa2ily and forward 2ail
First m!"t#
Use a :wellness; approach 6cards+ phone calls+ visits8 to contin3e to reinforce co2pany1s concern Consider 2edical e<a2ination by independent physician+ if warranted &eeval3ate treat2ent plan based on new 2edical infor2ation Update ret3rn7to7wor0 plan and contact the in53red e2ployee and9or the fa2ily
O"$!i"$
Contin3ally reeval3ate treat2ent plan &efer for pain 2anage2ent eval3ation of chronic pain+ if appropriate .aintain contact with the in53red e2ployee and9or the fa2ily
CHECKLIST
Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States and Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" AU!(.A! CA""' *E SUE% $ A C(U&! (, "A/. Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.
FOR COLLECTING INFORMATION FOR A CLAIM
/hether it1s the b3sinesses owner+ or so2eone assigned by the b3siness owner to 0eep trac0 of the clai2+ here1s so2e advice for the types of infor2ation the person overseeing the clai2 sho3ld be gathering4
A%!&t t#e em'l!yee
$a2e+ nic0na2es+ 2aiden na2e+ previo3s na2es Address=c3rrent and previo3s 6length of ti2e living at both addresses8 Phone n32ber+ pager n32ber+ cell3lar n32ber Social sec3rity and driver1s license n32bers Se< %ate of birth .arital stat3s %ependents and i22ediate fa2ily contact $on7relative contact %ate of hire 6state hired+ if applicable8 >ob classification+ if applicable 6ins3rance class or co2pany classification8 -ehicle 6type+ year+ license n32ber8 nterests=hobbies "ength of ti2e as a state resident
A%!&t t#e i"(&ry
!i2e and date of in53ry %ate of death 6if applicable8 State of in53ry $at3re of in53ry 6sprain+ fract3re+ etc.8 *ody part6s8 affected? any previo3s in53ry to the affected body part6s8
So3rce of in53ry 62achines+ hand tools+ b3ildings+ etc.8 !ype of in53ry 6fall+ str3c0 by ob5ect or vehicle+ overe<ertion+ repetitive 2otion tra32a8 /itnesses /or0 process involved 6lifting+ carrying+ etc.8 !o who2 was the in53ry reported /ho filled o3t the first report of in53ry report Plant or location >ob !i2e and date the in53ry was reported Shift+ if applicable
A%!&t t#e )laim %ate e2ployer first notified /ho was notified+ by who2@ %ate e2ployer was notified of wor0ers1 co2pensation clai2 %ate ins3rance co2pany or service co2pany notified Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.
%ate state agency notified

Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States and Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" AU!(.A! CA""' *E SUE% $ A C(U&! (, "A/. Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.
State case n32ber Average wee0ly wage *enefit rate )ealth care providers and costs (ther benefits lost 6%id the e2ployer stop paying vacation+ health benefits+ etc.@8 (ther benefits received %ate disability started %ate of first pay2ent Pro5ected ret3rn7to7wor0 date %ate case closed %ate of 2a<i232 2edical i2prove2ent 2pair2ent rating
"ost days !otal benefits paid -ocational rehabilitation activity S3brogation 6 s so2e third party responsible@8 Second in53ry f3nd potential
Oral stateme"t *r!m i"(&red w!r er
Cond3ct the interview in a non7adversarial setting %e2onstrate concern and e2pathy Allow the wor0er to tal0 %o not r3sh the wor0er &eenact the accident Chec0 for photos and9or video of the accident
Writte" stateme"t *r!m i"(&red w!r er $ote the location where the state2ent is ta0en "et the e2ployee write the state2ent+ if possible State2ent is ta0en ASAP after the in53ry %escribe the wor0er1 prein53ry and postin53ry actions &eA3est that the wor0er and any witnesses sign the state2ent .a0e s3re the e2ployee initials any changes #ive copy of state2ent to e2ployee list the date and ti2e of the state2ent Oral stateme"t *r!m wit"ess+es,
$ote witness1 location at the ti2e of in53ry &ecord witness1 relationship to the in53red wor0er nterview witnesses individ3ally %o not r3sh the witness .a0e s3re the state2ent is 3nrehearsed
Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.
Writte" stateme"t *r!m wit"ess+es,
.a0e s3re the witness writes the state2ent in in0 &ecord the stated ASAP after the in53ry .a0e s3re the witness records his9her actions before+ d3ring and after the ti2e of in53ry &eA3est that the witness sign the state2ent and initial any changes
&ecord the date and ti2e of the state2ent #ive a copy of the state2ent to the witness
I* liti$ati!" !))&rs
%efense attorney+ law fir2 Clai2ant attorney+ law fir2 dentify 53dge Costs of litigation 6spending 2ore than paying@8 )istory of disp3te Settle2ent
WARNING SIGNALS OF WORKERS COMPENSATION FRA-D

'o3 2ay not discri2inate against a wor0er who has filed previo3s wor0ers1 co2pensation clai2s. )owever+ when yo3 have several of the following s3spect behaviors present or yo3 observe an e2erging pattern+ don1t be afraid to investigate f3rther for possible fra3d or to forward yo3r s3spicions to the appropriate a3thority.
A%!&t t#e w!r er
!he in53red wor0er has an 3nstable wor0 history? i.e.+ an e2ployee who often changes 5obs !he clai2ant has a history of reporting s3b5ective in53ries which 2ay incl3de wor0ers1
co2pensation or liability clai2s !he clai2ant is consistently 3ncooperative !he in53red wor0er has been recently ter2inated+ de2oted+ or passed over for a pro2otion !he in53red wor0er is in line for early retire2ent !he in53red wor0er is 2a0ing e<cessive de2ands !he in53red wor0er calls soon after the in53ry and presses for a A3ic0 settle2ent of the case !he in53red wor0er 2oves o3t of state soon after the in53ry !he in53red wor0er changes his address to a post office bo< or receives 2ail via friend or relative
A%!&t t#e w!r 'la)e
!he in53red wor0er1s wor0place is e<periencing labor diffic3lties !he accident occ3rs 53st prior to 5ob ter2ination+ layoff+ after for2al discipline of the e2ployee+ or
near the end of the e2ployee1s probationary period
A%!&t t#e i"(&ry
!he in53red wor0er was not in53red in the presence of witnesses !he in53ry is a s3b5ective one+ li0e stress+ e2otional tra32a+ or is hard to prove+ li0e bac0 pain+ !he accident is not pro2ptly reported by the e2ployee to the e2ployer !he e2ployers1 first notice of the in53ry is fro2 an attorney or a 2edical clinic+ and not fro2 the Physicians who have e<a2ined the in53red wor0er have vastly differing opinions regarding the !here is no so3nd 2edical basis for the disability? all physicians1 reports indicate a f3ll recovery !he in53red wor0er is clai2ing disability e<ceeding that which is nor2ally consistent with s3ch an
in53red wor0er1s disability in53red wor0er headache+ inso2nia+ etc.
in53ry !he accident occ3rs late ,riday afternoon or shortly after the e2ployee reported on .onday !he clai2ant has the accident at an odd ti2e+ s3ch as at l3nch ho3r !he accident occ3rs in an area where the in53red e2ployee wo3ld not nor2ally be !he tas0 that ca3sed the accident is not the type that the e2ployee sho3ld be involved in? i.e.+ an office wor0er who is lifting heavy ob5ects on a loading doc0 !he details of the accident are vag3e or contradictory
A%!&t t#e medi)al relati!"s#i'
!he clai2ant freA3ently changes physicians or 2edical providers !he clai2ant changes physicians when a release for wor0 has been iss3ed A review of 2edical reports provides infor2ation that is inconsistent with the appearance or
behavior of an in53red person? i.e.+ a rehabilitation report describes the clai2ant as being 23sc3lar+ with call3sed hands and grease 3nder the fingernails !he e2ployer1s first report of in53ry contrasts with the description of the accident set forth in the 2edical history !he in53red wor0er develops a pattern of 2issing physician1s appoint2ents
A%!&t t#e )laim itsel* !r t#e )laima"ts att!r"ey
!he in53red wor0er1s attorney reA3ests that all chec0s and correspondence be sent to the !he clai2ant1s attorney is 0nown for handling s3spicio3s clai2s !he attorney lien or representation letter is dated the day of the reported accident !he sa2e doctor9lawyer co2bination previo3sly 0nown to handle the sa2e 0ind of in53ry is !he clai2ant is 3n3s3ally fa2iliar with wor0ers1 co2pensation clai2s proced3res and laws !he clai2ant initially wants to settle with the ins3rer b3t later retains an attorney and files
handling this clai2 attorney1s office
increasingly s3b5ective co2plaints !he clai2ant1s attorney threatens f3rther legal action 3nless a A3ic0 settle2ent is 2ade !here is a high n32ber of applications fro2 a specific fir2 !he clai2ant1s attorney inA3ires abo3t a settle2ent or b3yo3t early in the life of the clai2 !he clai2ant writes 3nsolicited state2ents abo3t how 23ch better he9she is+ b3t treat2ent contin3es and the clai2ant doesn1t ret3rn to wor0
A%!&t !&tside a)ti.ities
!here are tips fro2 fellow e2ployees+ friends+ or relatives s3ggesting that the in53red wor0er is !he in53red wor0er1s rehabilitation report shows evidence of other activity !he in53red wor0er is in a trade that wo3ld 2a0e it possible to otherwise wor0 while collecting !he in53red wor0er is e<aggerating an in53ry in order to get ti2e off to wor0 on personal interests? !he in53red wor0er is in a seasonal b3siness that wo3ld 2a0e it attractive to be :in53red; d3ring
i.e.+ the in53red wor0er is re2odeling or b3ilding a ho2e conc3rrently with the in53ry the off7season? i.e.+ occ3pations in fields s3ch as roofing+ landscaping+ pl32bing+ far2ing+ 2asonry+ etc. !he in53red wor0er leaves different dayti2e and evening telephone n32bers !he in53red wor0er is never ho2e when called or is always :sleeping and can1t be dist3rbed; 6especially d3ring wor0 ho3rs8 &et3rn calls to the clai2ant1s residence have strange or 3ne<pected bac0gro3nd noises that indicate it 2ay not be a residence !he clai2ant has several other fa2ily 2e2bers also receiving wor0ers1 co2pensation benefits or other :social ins3rance; benefits+ s3ch as 3ne2ploy2ent co2pensation either wor0ing or is active in sports

Checklist - Worker's Compensation Claims

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Checklist - Worker's Compensation Claims

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Copyright Envision Corporation. 2002. All rights reserved.

CHECKLIST HANDLING WORKERS COMPENSATION CLAIMS

Coordinate pay2ent of initial benefits

FOR COLLECTING INFORMATION FOR A CLAIM

A%!&t t#e em'l!yee

A%!&t t#e i"(&ry

%ate state agency notified

Oral stateme"t *r!m i"(&red w!r er

Writte" stateme"t *r!m wit"ess+es,

WARNING SIGNALS OF WORKERS COMPENSATION FRA-D

A%!&t t#e w!r er

A%!&t t#e w!r 'la)e

A%!&t t#e i"(&ry

A%!&t t#e medi)al relati!"s#i'

A%!&t t#e )laim itsel* !r t#e )laima"ts att!r"ey

A%!&t !&tside a)ti.ities

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