Reporting of Workers Compensation claims

By: Kathleen Murray, Capstone Brokerage Client Advocate, August 19, 2014

Timely Reporting of workers’ compensation claims are a key element in the workers’ compensation claims process. Prompt reporting of work-related injuries and illnesses can achieve better outcomes and lower overall workers’ compensation claims costs which are beneficial to an insured’s premium.

Whether it is an owner, supervisor, office manager or human resources manager, having consistent communication processes are vital to managing costs and prevent a litigated claim. Workers’ Compensation claims have a long claim life because of lifetime re-opening in Nevada and when litigation happens, the claim can continue for several years escalating premium costs and leading to frustration for both the injured worker and the insured. Promptly guiding injured workers to appropriate medical care can improve recovery times, strengthen communication and rapport with an injured employee and minimize an otherwise aggravating experience with the workers’ compensation claims process.

The Timely Reporting of workers’ compensation claims is a Six-Step Reporting Process: Here are six recommended steps:

1. The injured worker should immediately notify their employer of the workplace injury or accident – even if it is as minor as a paper cut! Paper cuts have been known to develop nasty infections. When the injured worker reports the claim, a C-1, Employee’s First Report of Injury should be completed and signed by the injured worker and representative of the company. If a C-1 form is not available, contact your broker immediately to obtain this form. If an injury or illness is acute, the Employer should always send the Employee to the nearest medical emergency department. Be sure that the name of the workers’ compensation carrier information is given to the emergency facility for proper billing to the workers’ compensation carrier. The injured worker is not to be billed for workers’ compensation treatment and evaluation.

2. The C-1 form should be kept on file in a separate workers’ compensation file – even if the employee does not seek treatment or evaluation on the same day. The Employee has 5 days from the date of the 1st report of Injury to seek evaluation and treatment. The C-1 is documentation that the claim was reported by the Employee.

3. The Injured Employee should seek treatment from a network or certified provider. In an emergency, treatment should be sought at the nearest medical facility.

4. The Employer should insure the Injured Worker has appropriate transportation to receive initial medical treatment, especially if the Employee’s injury would prevent him/her from driving on their own.

5. When the Injured Employee has received treatment, a C-3 Form, “Employer’s First Report of Injury must be completed by the Employer and submitted to the carrier immediately. If the clam is not reported immediately, claim denial could be the result and invites litigation. Most carriers have an 800 reporting line to accomplish reporting from the Employer. If in doubt, contact your broker who will be able to assist with this information. When the claim is reported, a claim number will be assigned to be used throughout the life of the workers’ compensation claim.

6. The Employer, Supervisor or Human Resources Department representative should always gather pertinent facts about the work-related illness or injury. This documentation is vital to the workers’ compensation claim and should be part of the claim reporting procedure.

Working with your broker, insurance carrier and adjuster are vital during the claims process toward the achievement of a positive outcome in a workers’ compensation claim.