Companies today are in a continual state of change to maintain competitiveness. As a result, new processes and variables find their way into the company and can change the dynamics of a company. Planning and anticipation are key activities for just about every phase of business, including dealing with the potential for employee injuries.

Accident prevention and claims management are two areas that  require significant consideration. Negligence and lax policies can result in huge financial losses and even damage to your business reputation.

Managing employee claims effectively will reduce the possibility of antagonistic pursuit of fraudulent claims by disgruntled employees. Efficient and effective claims management programs designed to show compassion for employee welfare can significantly reduce time and money spent to rectify a potentially difficult situation. Prompt attention is critical, since the cost tends to increase the longer a claim is kept open.

What’s the correlation between Workers’ Compensation and Personal Injury Claims?

If an injury at work occurs, but is not due to negligence on the part of the employer, Workers’ Compensation is designed to compensate the individual for loss of income. Even if the injury was caused by the individual’s negligence, Workers’ Compensation will apply.
If the injured party believes that the employer is at fault, the individual may file a personal injury claim to recover damages. These damages may include compensation for medical costs, loss of earnings, pain and suffering, and continuing conditions, all of which can add up to huge sums. In any event, proving that the injury is the fault of the employer is necessary for the pursuit of personal injury claims.

What are the key elements of an effective claims management program?

  • An effective Risk Management Information System (RMIS) is a foundational element of an effective claims management program. Proper employee orientation and easy access to the RMIS can demonstrate the company’s authentic concern for employee welfare by presenting a well-conceived process for dealing with potential problems.
  • Immediate response is an important element for dealing with injuries on the job. Taking longer to recognize an issue often results in employee disgruntlement that may lead to aggressive compensation claims. If the employer demonstrates a lack of concern, the employee might feel betrayed and decide to pursue a lawsuit out of spite.
  • Medical treatment should be immediate and as complete as possible. The employer should make every effort to address the problem and demonstrate their complete concern for the employee’s welfare.
  • Investigation into the details of the injury should also begin immediately. Since a first step in the claims process requires the employer to accept or contest the claim, an immediate and thorough investigation of the event must be performed.
  • Execute a complete survey of your business to determine critical control points at which injuries may occur. It is advisable to utilize experts in the area of personal injury prevention. In occupations in which machinery is involved, manufacturing and product handling processes should be subjected to detailed review. Your liability insurance company should also provide an expert to review the facilities and processes for potential problems.
  • Create training programs for each position along with clear step-by-step procedures for each function.
  • Post warnings about potential hazards.
  • Provide medical supplies onsite.
  • Adopt cleaning and organizational processes that minimize exposure to hazardous conditions.

If the employee decides to file a personal injury claim, how should the company respond?

Effective claim administration includes an early decision on whether to contest or accept the claim. But that decision should not be made until the company has examined each element of the potential causes of the injury, the extent of the injuries and events that led up to and followed the accident.

Determination of the actual extent of the injury plays a key role on the decision as well, as a final accurate determination of the extent of the injuries will drive the total cost of treatment as well as the length of the injured party’s financial remuneration.

Who should assist with the development and execution of an effective claims management program?

The insurance company can provide significant experience and insight into effective claims management. In the case of a self-insured company, an attorney with considerable claims liability experience is a critical partner in the process.

An experienced third-party advisor can bring objective input into the process and can offer valuable insight into a company’s vulnerabilities. For more information about how you can reduce your company’s liability by utilizing a PEO, contact us today.