By: OneGroup
Managing workers’ compensation claims can be daunting. There are some key items to be aware of in order to effectively work through this process. With the state’s revision to the rating formula for the Experience Modification Rate (EMR) in 2022 and evolving trends in the claims world, workers’ compensation claims are having a significant impact on businesses. Variables like this make it even more important to pay attention in the unfortunate event of a claim. This article outlines the essential steps employers should take following a workplace accident to ensure the best possible outcome for their business.
Immediate Response to an Accident
When an accident occurs, the first step is to investigate the claim thoroughly. This involves gathering detailed information about the incident, including the who, what, where, when, and how. It’s crucial to ask as many questions as possible early on to capture accurate details before memories fade or stories change.
Key steps include:
- Interviewing the injured employee: Ask specific questions about what happened, how it happened, and where it happened.
- Examining the accident site: Verify any claims about broken equipment or hazardous conditions.
- Identifying witnesses: Speak to coworkers immediately to get their accounts before they have a chance to discuss the incident among themselves.
Documentation
Proper documentation is vital in managing workers’ compensation claims. Employers should use incident reports to record all relevant details. If an incident report is not immediately available, have the employee write a statement or write it for them and have them sign it. This creates a paper trail that can be crucial if the claim is later disputed.
Important documentation practices include:
- Detailed incident reports: Ensure they cover the who, what, where, when, and why. The injured employee needs to sign and date the document.
- Specific injury details: Clearly document the body part or parts injured to minimize the potential for the claim to evolve and include other sites.
- Witness statements: Collect and have witnesses sign their statements immediately. Try to secure a phone number, home, and email addresses for the witness.
Reporting Process
Employers must document and maintain a record of any injury or illness for 18 years. The injury or illness must be reported to the insurance carrier (and the Board) within 10 days of the disability or employer knowledge of disability—defined as lost time or restricted duty—if there is more than one day of lost time beyond the shift when the injury occurred or if medical treatment extends beyond first aid.
Steps in the reporting process:
- Timely reporting: Ensure the claim is reported to the insurance carrier within the mandated timeframe to avoid penalties, and to provide time for the carrier to investigate the loss. Reference New York form C-2F (Employer’s First Report of Work-Related Injury/Illness) for information the carrier will need. Contact your broker if you are uncertain how to report a loss.
- Share your concerns: If you question a loss or there are details which seem important which are not addressed in reporting, let the carrier know you would like to be contacted to discuss further. When the carrier contacts you, it is appropriate to share your concerns with them.
- Let the employee know you have reported the loss. If a claim number is provided by the carrier, share that with the employee. Medical providers will request this information at the time of treatment.
- Involve risk management: Reporting losses helps identify and address potentially hazardous situations and avoid future incidents.
- Electronic Data Interchange (EDI): Understand that state-mandated EDI reporting requires timely and accurate submission to avoid penalties.
Components of a Claim
A workers’ compensation claim typically includes several components:
- Indemnity: Payments for lost time, which can be a temporary closed period of lost time or a schedule loss of use (SLU) award or Loss of Wage-Earning Capacity (LWEC) award for permanent injuries.
- Medical expenses: These are lifetime expenses and can increase annually due to rising average weekly wages and fee schedules.
Active Management of Claims
Active management of claims is crucial for minimizing costs and ensuring a positive outcome. Employers should:
- Provide prompt medical attention: This helps the injured employee recover quicker and return to work, even in a limited role, which can reduce the overall cost of the claim.
- Engage in proactive communication: Keeping open lines of communication with the injured employee can foster a sense of loyalty and reduce the likelihood of litigation. Set the expectation that employees inform you and provide documentation of their medical examination dates and status after each appointment. Failure to do so may jeopardize their workers’ compensation benefits and perhaps their employment status. Share the medical status information with your carrier.
- Inform your carrier when an employee’s work status changes (out of work, returns in a transitional duty capacity, returns full duty, etc.)
- Update your carrier with any relevant developments you become aware of, i.e., employee is unable to work but is still participating in outside activities, etc. Don’t assume the carrier shares your knowledge.
- Complete the forms. Yes, there are many. Yes, they are cumbersome. However, if they are not completed fully and accurately, you will be asked to do them again. If you do not, penalties and adverse findings will follow. Do it right and do it once! (If you have questions on how to complete, ask your broker before you submit)
In Summary
Effective management of workers’ compensation claims involves prompt investigation, thorough documentation, timely reporting, and active management. By following these steps, employers can mitigate the impact of claims on their business and ensure compliance with state regulations. Proper handling of claims not only helps in reducing costs but also supports a safer workplace environment.
If you have any questions or need further assistance, please do not hesitate to reach out to OneGroup’s team for guidance and support.
Clark Equipment Rental and Sales of Canastota celebrates its 20th anniversary next year – an impressive milestone for any business today – and owner Adam Clark is planning for the next twenty. Clark’s origin story began in grade school; through his dedication to customer satisfaction and adapting to changing client needs, he’s built an impressive reputation.
Clark started out working from a storage unit in Syracuse. From there, he moved to a one-acre property with a 3,600-square-foot warehouse. The next move increased the physical space to about six acres with a 7,000-square-foot building.
“When I first started, I was so small, I couldn’t help but get to know customers personally,” Clark said.
“We’ve kept that personal touch,” Clark agreed.
“We have a lot of repeat business because people like our customer service,” Stone said. “Max has a lot of repeat customers thanks to his efforts and everything service does to get equipment ready and help customers once they have it. If they have a problem, we try to help them through it. It’s harder when they’re out of state, but we can still point them in the right direction, whether they need parts or service.”
Newer-model machines without the new equipment price
“It’s easier to manage the inventory,” he said. “I’m very particular about the way my equipment looks and how it’s maintained. With everything in one location, it makes things much easier for my staff and customers.”
“The challenge for me will be managing subsequent locations successfully, then keep rolling them out,” Clark said. “We have between 600 and 700 machines and sell 30 to 50 machines monthly. We rent a few hundred machines every month. The operation is pretty amenable to scaling. I just need a couple more key people – a couple more mechanics and one or two more good over-the-road salespeople. A couple more years of saving my pennies and we’ll open another store. Growing the business is fun.”
Central New York is a region rich in history, culture, and natural beauty. Amidst the picturesque landscapes and vibrant communities, manufacturing stands as a cornerstone of the local economy, driving growth, innovation, and opportunity. As we explore the unique regional economic landscape, one quickly sees that manufacturing plays a pivotal role in shaping our prosperity. And, with the arrival of Micron Technology and its supply chain, the influence of manufacturing will only continue to grow.
In 2019, the Climate Leadership and Community Protection Act (CLCPA) was passed by the New York State Assembly and the New York State Senate, then signed into law by former Governor Andrew Cuomo. This legislation requires New York State to reduce greenhouse gas emissions by 40% in 2030, and 85% by 2050 from 1990 levels. In addition, the CLCPA requires establishing a 100% clean electrical grid by 2040.
Despite the on going inflationary environment, workers’ compensation costs are set to decrease for the eighth consecutive year on October 1, 2024. Overall, loss costs and resulting rates will drop by an average of 9% across all class codes. However, this change may vary depending on specific class codes, with some seeing increases and others decreases, but the overall net decrease averages 9%.