Checklist for handling claims and collecting information

Checklist for handling claims

The initial period is critical in handling workers' compensation claims. Be sure to:

Immediately

• Administer first aid

• Accompany injured worker to a selected medical provider

• Report incident within organization

• Notify family

• Assign case manager or other responsible person to follow claim.

First day

• Report to claim handler outside organization (insurance organization or third-party administrator)

• Determine, on a preliminary basis, whether the injury is covered by workers' compensation

• Contact union, if applicable

• Counsel employee and/or family on claims procedures, available benefits, organization'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 organization's concern

• Consider medical examination by independent physician, if warranted

• Reevaluate treatment plan based on new medical information

• Update return-to-work plan

• Check for third-party involvement for possible Second Injury Fund recovery

• 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. The manager or supervisor of the employee will often be the focal person for the claim. The person may communicate with the injured employee or the family, with the treating physician, and with the insurance organization. The following information is a place to start:

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

• State hired and date of hire

• Job classification (insurance class or organization 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, 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

• Department

• Supervisor

• Job

• Time and date the injury was reported

• Shift.

About the claim

• Date employer first notified

• Who was notified, by whom?

• Date employer's workers' compensation claims department notified

• Date insurance organization or service organization 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 nonadversarial 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's preinjury and postinjury 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

• 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

• make sure the witness writes the statement in ink

• record the statement 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.