Checklist for Handling Worker's
Compensation Claims
Immediately
administer first aid
accompany injured worker to a selected medical provider
report incident within company
notify family
assign responsible person to follow claim
First day
- report to claim handler outside company (insurance company or third-party
administrator)
- determine, on a preliminary basis, whether the injury is covered by workers’
compensation
- counsel employee and/or family on claims procedures, available benefits,
company’s continuing interest in employee’s welfare, etc.
- follow up with the employee or family
First week
- coordinate payment of initial benefits
- talk to treating physician to learn diagnosis and treatment plan
- evaluate whether medical rehabilitation is necessary or appropriate
- develop return-to-work plan
- forward mail
- contact the injured employee and/or the family
First month
- use a "wellness" approach (cards, phone calls, visits) to continue
to reinforce company’s concern
- consider medical examination by independent physician, if warranted
- reevaluate treatment plan based on new medical information
- update return-to-work plan
- contact the injured employee and/or the family
Ongoing
- continually reevaluate treatment plan
- update return-to-work plan
- refer for vocational rehabilitation
- refer for pain management evaluation of chronic pain, if appropriate
- maintain contact with the injured employee and/or the family
Checklist for collecting information
Whether it’s the businesses owner, or someone assigned by the business
owner to keep track of the claim, here’s some advice for the types of
information the person overseeing the claim should be gathering:
About the employee
- name, nicknames, maiden name, previous names
- address—current and previous (length of time living at both addresses)
- phone number, pager number, cellular number
- social security and driver’s license numbers
- sex
- date of birth
- marital status
- dependents and immediate family contact
- non-relative contact
- date of hire (state hired, if applicable)
- job classification, if applicable (insurance class or company
classification)
- vehicle (type, year, license number)
- interests—hobbies
- length of time as a state resident
About the injury
- time and date of injury
- date of death (if applicable)
- state of injury
- nature of injury (sprain, fracture, etc.)
- body part(s) affected; any previous injury to the affected body part(s)
- source of injury (machines, hand tools, buildings, etc.)
- type of injury (fall, struck by object or vehicle, overexertion, repetitive
motion trauma)
- witnesses
- work process involved (lifting, carrying, etc.)
- to whom was the injury reported
- who filled out the first report of injury report
- plant or location
- job
- time and date the injury was reported
- shift, if applicable
About the claim
date employer first notified
who was notified, by whom?
date employer was notified of workers’ compensation claim
date insurance company or service company notified
date state agency notified
state case number
average weekly wage
benefit rate
health care providers
health care costs
other benefits lost (Did the employer stop paying vacation, health benefits,
etc.?)
other benefits received
offset for other benefits
date disability started
date of first payment
projected return-to-work date
date case closed
date of maximum medical improvement
impairment rating
lost days
total benefits paid
reserves
vocational rehabilitation activity
subrogation (Is some third party responsible?)
second injury fund potential
Oral statement from injured worker
- conduct the interview in a non-adversarial setting
- demonstrate concern and empathy
- allow the worker to talk
- do not rush the worker
- reenact the accident
- check for photos and/or video of the accident
Written statement from injured worker
- note the location where the statement is taken
- let the employee write the statement, if possible
- statement should be written in ink
- statement is taken ASAP after the injury
- describe the worker’ pre-injury and post-injury actions
- request that the worker and any witnesses sign the statement
- make sure the employee initials any changes
- give copy of statement to employee
- list the date and time of the statement
Oral statement from witness(es)
- note witness’ location at the time of injury
- record witness’ relationship to the injured worker
- interview witnesses individually
- do not rush the witness
- make sure the statement is unrehearsed
Written statement from witness(es)
- make sure the witness writes the statement in ink
- record the stated ASAP after the injury
- make sure the witness records his/her actions before, during and after the
time of injury
- request that the witness sign the statement and initial any changes
- record the date and time of the statement
- give a copy of the statement to the witness
If litigation occurs
- defense attorney, law firm
- claimant attorney, law firm
- judge
- costs of litigation (spending more than paying?)
- history of dispute
- settlement