Checklist: Handling Claims and Collecting Information
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 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
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.
Reprinted with permission. © CCH
<p>Checklist: Handling Claims and Collecting Information. The initial period is critical in handling workers' compensation claims.</p>
Checklist: Handling Claims and Collecting Information
/resources/checklists/checklist_handling_claims_and_collecting_information.aspx
2405
none