Claim adjusters’ best tips to avoid workers’ comp missteps

SFM’s claims representatives spend all day managing workers’ compensation claims. They coordinate with injured workers, employers and medical providers. Many of them have decades of experience in the field. So, when we asked them to give us their top tips for employers, they delivered.

Here’s what the claims adjusters said:

  • When hiring, include the physical demands of the job in the job description. Have prospective candidates sign off on the descriptions to signify that they can perform the essential functions of the job. Pre-employment physicals and criminal background checks are also important.
  • Always investigate after an injury. Document how, when and where the accident occurred. Talk with the injured employee and witnesses, and take photos. If you have surveillance cameras in the area, let the claims representative know. Then figure out how to prevent it from happening again. This information also helps claims representatives to verify what they are told by the injured worker.
  • When bringing employees back to work, work together with the employee to look for ways they can perform their job within their medical restrictions. Your claims representative can also provide suggestions and resources if needed. Require the employee and supervisor to commit to working within those restrictions. It’s always good to put it in writing and get everyone to sign off.
  • Be sure to tell your claims representative right away when an employee starts needing time off for a work injury and when the employee returns to work so that benefit payments are on time and correct.
  • Focus on building strong relationships between employees and direct supervisors.
  • Continue communicating with injured employees, even if they are totally disabled and unable to return to work. Keeping the lines of communication open and letting employees know you care about them is really important.
  • Address disciplinary issues with staff right away. If you don’t, and the employee is injured, these issues become much more difficult to deal with.
  • If an employee is injured in a work-related automobile accident, be sure to send the claim to both your workers’ compensation and auto insurer. If the injury is work-related, workers’ compensation provides primary coverage, and your insurer will pursue recovery from an at-fault party.
  • Make a copy of any paperwork an injured worker brings in, especially any doctor’s reports, and forward to the claims representative.
  • Report all claims right away.
  • Allow your claims representative to deliver hard-to-hear news to the injured worker versus doing it yourself. That helps you maintain a positive relationship with the employee, which is more conducive to a speedy and effective return to work.

 For more tips, read four things you need to do after an employee is injured.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

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