The Employer’s Role in the California Workers Compensation Process
When it comes to advice on how best to manage California workers compensation insurance claims, employers have been told for years to be proactive, take control, and stay involved. All great advice, but too often the conversation ends there. So what do those things really mean?
Let’s start by looking at the four phases of an employer’s involvement in the workers’ compensation claim process:
- The pre-injury phase
- The injury occurrence phase
- The claim phase
- The settlement phase
An employer’s involvement in the process actually begins before the injury occurs, and it doesn’t end until the injured employee is back to work and fully recovered from the injury. And what you do during each phase can have a huge impact on the ultimate cost of your workers compensation claims, and on your premiums.
Here are some of the key things employers should be doing during each phase of the claim process to be proactive, take control, and stay involved in claims.
The pre-injury phase
If you have employees, you’re going to have injuries and workers’ compensation claims. But there are things you can do prior to injuries occurring that will impact the ultimate cost and outcome of claims:
- Have a strong safety program.
- Instruct new hires on what to do in case of an accidental injury.
- Provide supervisors instructions on how to report and be involved in claims.
- Have a written transitional duty policy and return to work strategy.
- Have a medical provider network in place through your insurance carrier.
- Instruct your employees that workers’ comp fraud is a crime and will be prosecuted.
- Clearly post all required notices including WC laws, OSHA posters, etc.
The injury phase
You can’t prevent every injury, but your immediate actions after an injury will impact the outcome of the claim. Make sure you:
- Arrange immediate medical assistance for the injured worker.
- Don’t let employees with minor injuries or soft tissue strains wait to obtain medical assistance; many will end up going to the ER or their own physician, which will drive up claim costs.
- Advise the treating physician of any temporary jobs and/or modifications you can provide to accommodate any work restrictions.
- Strive to get all injured employees back to work within 1 to 3 days after the injury, on modified duty if necessary, unless they are medically unable.
The claim phase
Too many employers send the injured worker to the doctor and forget it. That’s a huge mistake. You need to:
- Report the claim to your insurance carrier or third party claims administrator immediately.
- Complete the Employer’s Report of Injury and any other required paperwork, and don’t miss filing deadlines.
- Provide the adjuster with key information including the employee’s wage information and any history of workers’ comp claims.
- Identify transitional work the injured employee can perform within the treating physician’s restrictions.
- Regularly communicate with the injured worker to show your concern.
- Notify the claims adjuster immediately if you’re contacted by an attorney representing the employee.
- Monitor and review claim related paperwork filed by the adjuster, as well as any Workers’ Compensation Board decisions, and beware of time limits for disputing decisions.
- Monitor medical progress reports to make sure treatment is appropriate.
The settlement phase
Although the claims adjuster usually negotiates claim settlement, there are times the employer may need to be involved, including:
- Attending depositions and hearings.
- Attending the settlement conference.
- Evaluating permanent work restrictions to determine if return to the employee’s prior position, or a new/altered position, is possible. This determination dictates additional benefits and settlement amounts and method.
By staying involved in your California workers compensation insurance claims from pre-injury to claim settlement, you can take a huge bite out of claim costs and your overall workers’ compensation costs. Want to learn more? Contact the California Workers Compensation specialists at Republic Capital Claims Administrators today.