reading this nuts and bolts information will help!
Many times, we receive
distress calls from clients with concerns that cross the
spectrum of claim management, such as: determining if the
injury is first aid or recordable; how to ensure employees
attend medical appointments with the occupational clinic;
handling employees who don't attend medical appoints or
follow their work restrictions; return to work; and
accommodating restrictions on the job.
To avoid getting frustrated
with the workers compensation process, it's important to get
back to the basics of managing a claim.
Workplace Injury Occurs
When a workplace injury
occurs, it is important to provide whatever emergency
medical care is necessary, then determine if the injury is
considered first aid or recordable.
First aid is defined as any
one-time treatment and any follow-up visit for the purpose
of observation of minor scratches, cuts, burns, splinters,
or other minor industrial injuries, which do not ordinarily
require medical care.
If the injury results in one
of the following, it is considered recordable and must be
recorded on the Cal/OSHA 300 log: Death; days away from
work; loss of consciousness; restricted work or transfer to
another job; medical treatment beyond first aid; a
significant injury/illness diagnoses; all work-related
needle-sticks and cuts from sharp objects that are
contaminated with another persons blood or potentially
infectious material; certain cases involving exposures to
In the event of a recordable
injury: Provide the employee with the Employee's Claim Form
for Workers' Compensation Benefits form (DWC Form 1).
Contact your workers' compensation carrier and file the
Employer's First Report of Occupational Injury and Illness
form (DLSR Form 5020) no later than five days after
the injury occurs. Record the incident on the Cal/OSHA
300 log, and in some cases you may need to contact Cal/OSHA
directly to report the injury.
Finally, it's very important
to investigate the incident and take corrective action, if
the injured worker and communicating expectations
This can prove to be the most
difficult aspect of the claim. One common myth is that
employers can not discipline or terminate employees who have
filed a workers' compensation claim. As noted, that is a
myth as a workers' compensation claim is not an employee's
free ticket to poor performance and attendance. You can
manage poor performance and must do so diligently
through proper communication with the employee, by following
a progressive discipline process, and maintaining good
some tips on how to successfully manage a claim and
scenarios we commonly see in the work place.
When an injury occurs, tell
the employee you are concerned about their well-being and
that you want to do everything possible to help them recover
and come back to work. Familiarize the employee with the
workers' compensation process and their responsibility to
complete necessary claim forms, attend medical appointments,
adhere to work restrictions, and to maintain a satisfactory
level of work performance and attendance. Also, inform the
employee what impact any lost time will have on their pay,
medical benefits coverage, and vacation/sick accrual. For
employers with 50 or more employees, designate all workers'
compensation leaves as FMLA/CFRA.
Calendar and track the
employee's appointments with medical providers. Contact the
employee before each appointment to remind them of the
appointment. Call the medical provider after any scheduled
appointment if you do not receive a treatment report. Work
with the medical provider to establish light duty guidelines
for the injured employee.
Employees don't complete
and return the DWC Form 1. This doesn't relieve you of
your obligation to report the injury to the carrier.
Document when you gave the DWC Form 1 to the employee and
attempts made to contact the employee to obtain the
The employee refuses to
file a claim for their work-related injury. A claim
still must be filed and reported to the carrier and an
investigation completed if applicable. The carrier will
determine how to handle the claim and if the employee should
complete a waiver to waive medical treatment under the
workers' compensation system. In this case, if the employee
is unable to perform all tasks of the job, in a satisfactory
manner, then the situation becomes a performance issue and
you should follow your company's progressive discipline
The employee files a claim
and misses medical appointments. Meet with the employee
each time he/she misses an appointment and inform him/her
that it is not acceptable to miss their appointments. Inform
the employee that missed appointments can negatively affect
their claim and timely payments, and is considered
unsatisfactory performance as the employee is expected to
attend their appointments. Follow your progressive
discipline process for unsatisfactory work performance, and
notify your carrier immediately.
The employee is not
adhering to the medical providers' work restrictions.
Meet with the employee each time you are made aware that
he/she is not complying with work restrictions. Inform the
employee that he/she is required to adhere to the medical
restrictions and it is expected as part of their job.
Failing to adhere to the work restrictions could negatively
impact their claim and payments, cause further injury, and
is considered unsatisfactory performance. Follow your
progressive discipline process for unsatisfactory work
performance, and notify your carrier immediately.
CAUTION!! In any
of the above scenarios, it is critical to keep your workers'
compensation carrier and human resource contact abreast of
the issues each step of the way. If the employee's
performance doesn't improve, you may need to consider
termination but only after having reviewed the
circumstances surrounding this case with your human resource
contact, your carrier, and legal counsel if appropriate.
It is essential for the
company to review the work restrictions with the medical
provider and evaluate whether or not the company can
reasonably accommodate the restrictions. It's also important
to engage in an interactive process with the employee. What
that means is, talk with the employee about the work
restrictions (or needed accommodations) and discuss any
suggestions or ideas the employee and company may have about
how to make the accommodations. The company may, and can,
determine they can't accommodate the restrictions or provide
modified work for the employee based on business needs.
Later, if business circumstances change, the company can
re-evaluate the situation and determine if they can
accommodate the restrictions.
It is highly recommended
that the company make every effort to have light duty
work available. There are so many benefits to returning
injured employees back to work, such as, employees typically
heal faster, their morale is higher, they feel as if the
employer cares about them, and the employee feels engaged
and wants to recover. Keep in mind, light duty assignments
can be in other departments doing very different tasks over
their normal job prior to the injury.