The most important steps an employer can take to optimize the results of workers’ compensation claims are those actions taken immediately upon notice of injury. When an employee claims a work-related injury you are obligated to provide the employee with a DWC-1 Claim Form within 24 hours. You should also send the employee for medical treatment, even if you question the industrial nature of the injury. The claim should be reported to ALPHA Fund as soon as possible, and immediately in the event of serious injury, a questionable claim or one in which you have concerns of any kind.
Action taken early in the claim sets the tone for the balance of the claim. There is a direct correlation between lack of communication and claims outcomes. The less communication between the employer, claims examiner and the injured employee, the more expensive the claim is likely to become. We encourage you to maintain regular contact with both your ALPHA Fund Claims Examiner as well as your injured employee. While you should not discuss the medical nature of the injury, it is often a comfort to an employee to know that their employer is concerned for their well-being and looking forward to their return to work. When the employer or supervisor shows concern regarding their employee, the employee returns to work more rapidly and litigation is greatly reduced.
Timely reporting of claims to ALPHA Fund also has an impact on overall outcomes of claims. Timely reporting allows us to complete our initial assessment, coordinate medical care and explain benefits to your employee without delay. When an employee is unable to work as a result of their injury, they are understandably concerned about their finances and how they will take care of their family, bills and other needs. Add the unknown medical healing process to financial worries and you can understand why an injured employee may be apprehensive immediately following an injury. The sooner ALPHA Fund completes our assessment, the sooner we can initiate any benefits due and ease concerns of your injured employee.
Include as much information as possible when reporting claims to ALPHA Fund. While we do conduct an initial review into the circumstances of the accident, your initial information is a vital tool in ensuring the claims team is fully informed about the accident. Having your injured employee complete a written Accident Report is one way to solidify what occurred. This not only allows the Claims Team to understand the mechanics of injury and make more timely determinations of compensability but it also allows for our Loss Prevention Team to better identify areas where your organization may benefit from additional Loss Prevention training.
After we receive a claim you will receive a phone call or email from the Claims Team. We are contacting you to verify the information provided on the Employers Report (form 5020) and to obtain further information that may be helpful to the claim. While some of the questions we ask may not appear germane to the claim at this time, these questions are foundational and can become very important in the months or years ahead as medical treatment continues and the claim process moves forward. Your full and complete answers to all of our questions can become pivotal at a later point, in the event of protracted treatment or litigation.
Remember – you are our eyes and ears – we do not know your employees the way you know your employees. As they say at the airport, “See something; Say something”. Do not assume that the Claims Team will identify your concerns – if you have concerns, tell the Claims Team. Our role is to ensure your injured employees receive all benefits to which they are entitled under the law. If you have a concern on behalf of or regarding the claim of one of your employees, notify your Claims Examiner – open communication is critical in the claims process.