It’s ideal to report a workers’ compensation claim as quickly as possible. Prompt reporting is known to help lower claim expenses, prevent lawsuits, and helps injured workers get the care they need ASAP. Let’s go over why timely claim reporting, especially in the first 24 hours, matters.
4 Timely Claim Reporting Benefits
1. LOWER COSTS – MEDICAL AND PREMIUM
Swift reporting of a claim helps keep medical costs down. Many workplace injuries worsen over time, but the symptoms appear mild early on. Prompt reporting and medical treatment can prevent injuries from becoming more severe and expensive.
Implementing a nurse triage program can help employees get the correct care and, in some cases, eliminate unnecessary emergency room visits. This lowers medical costs and work comp costs.
2. IDENTIFY POTENTIAL FRAUD
According to Risk & Insurance, research indicates that 1-2% of workers compensation claims are fraudulent, costing the insurance industry $306.8 billion. Delayed reporting or Monday morning reporting may enable workers to prepare for their false claims with seemingly convincing evidence. The sooner the workplace injury is reported, the more easily a claims investigator can determine if the claim is truthful and legitimate. This also allows for investigation, pictures, preservation of the cause of the injury and witness statements.
3. MITIGATE LEGAL RISKS AND PENALTIES
OSHA has very specific rules and reporting requirements regarding workplace injuries. It’s important that your business know and comply with various state laws or you may face steep penalties.
OSHA has reporting requirements, as follows:
- Fatalities must be reported within 8 hours
- Amputations, loss of an eye, or inpatient hospitalization must be reported
- You must report the above situations if they occur within 24 hours
Be aware of state requirements as well.
Each state is different when it comes to the length of time an employee has to report a workers comp claim – make sure this is communicated to employees before an injury. Employers should report the claim and file a first report of injury as soon as they have been made aware of the injured workers claim. The claim process becomes very problematic if there are delays with reporting and depending on the type of injury there are also regulatory aspects that may violated. Many states impose fines on employers who delay reporting after a certain amount of time.
4. CLOSE CLAIMS FASTER
The average workers’ comp settlement takes 16 months. The longer a claim is open, usually the more costly it is. There are number of reasons a claim may stay open that are valid and in some cases, the waiting may be until the injured worker heals fully. Open claims with extra reserves also increase premiums.
Once the insurance company receives the first report of injury from the employer, the claims process starts. It’s important that all parties be cooperative in the process. In the event the injured worker wants a second opinion, they are entitled to it. Most often the injured worker will work within the network of physicians the insurance carrier uses, but not all the time.
Most often, people want instant action. If a claim is not reported quickly it may lead to frustrated workers. Waiting on others for medical care can quickly make the process problematic. Many times an injured worker who doesn’t feel as though they are being heard will retain an attorney. While there may be times an injured worker needs legal representation, this usually adds to the claim length and cost.
How to Encourage Timely Claim Reporting
Here are 3 things companies can do to encourage fast reporting:
ELIMINATE CONFUSION
The claim reporting process should be written, communicated and posted. Document the process with written procedures, make sure managers are on board, and make sure employees are trained.
HAVE A POSITIVE COMPANY CULTURE
Employees may be scared to report as they think there will be a negative reaction. Let employees know you encourage reporting, no matter the severity of the injury. This will lead to a great risk management tactic – near miss reporting!
SEEK THE BEST CARE
Employers should have an established relationship with a clinic or consider a nurse triage program to make sure employees have the best possible care. The nurse triage hotline number or clinic should be shared with employees and be incorporated in the reporting process.
If you want to talk more about the claim reporting process, email our team at [email protected] or check out our other blog posts for more work comp education.