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How Employers Can Break Through Work Comp Claim Dysfunction

sad dog sad work comp employeeJODI MATHY
HNI Senior Claims Consultant

Many employers will encounter a particularly challenging type of employee — the employee you suspect is "gaming the system" when it comes to a work comp claim.

There are two causes that lead to this behavior. The first cause could be a personality flaw or characteristic that makes the employee feel entitled. There are all kinds of pre-employment personality tests that could help identify this type of person. Please note that personality tests are not foolproof, but you can look at them as another tool in your toolbox. Experiment and see what works best for your firm!

The more common cause of this gaming-the-system of behavior is how the employer manages the employee during a period of healing.

How Employers Fail Injured Employees

How employers treat employees post-injury can have a major impact. In many situations, the employer disconnects, turns over the claim to the insurance carrier, and the employee is left feeling like she has been discarded.

When an employee doesn't feel that the employer genuinely is concerned about her injury and recovery, she may become disgruntled. Add to this the fact that an injured employee may not be receiving good communication from the insurance carrier, which could lead to late pay and uncoordinated medical care. When employees feels helpless, they seek help from the closest "experienced" friend, family member — or an attorney.

There are a few steps employers can take to do right by an injured employee (and to protect themselves from workers who might be abusing the system). This audit of the claims process has four elements:

1.) Make sure the employee is receiving his benefits on time

If the carrier is relying on getting payroll information from the employer, this should be done immediately. Employers cannot take the attitude of "I'll get to it when I get to it." When an employee can't pay his bills or enjoy simple things in life because of an injury, he will become jaded fast!

2.) Call the employee periodically to see how he is feeling

This should be done by someone who knows the employee. A direct supervisor is the best candidate. Avoid having an HR manager with whom they have no rapport — make the call. Don't underestimate the power of those human connections, and be prepared to exercise those listening skills!

3.) Give the employee a preview of post-injury job responsibilities 

Light and modified work programs should be communicated to employees during their initial training, and it should be clear that the employer is dedicated to return to work and why. This way, when employees are offered alternate work, they don't feel as though the tasks are punitive or retaliation.

4.) Get involved in conversations with the adjuster

As an employer, work with the adjuster to solve problems that the employee brings to you. Don't turn your back on the employee. Telling an employee that he needs to call the insurance company and that you can't help him is passing the buck. Get on a conference call with the adjuster and talk about the concerns.

Workers' compensation claims do not need to be adversarial. If attitudes are negative from the beginning, then the claim is destined to have a bad outcome.

Employers can protect themselves by performing a personality test during hiring and by having a sound claim management process. Using these steps will improve the claim experience for all parties.


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Photo by Jason via Flickr

Topics: Construction Transportation Safety / Compliance Manufacturing