Mitigating workers' comp costs with proper claim handling

Preventing workplace accidents should be first and foremost on an employer’s agenda. However, what should an employer do when the inevitable workplace accident occurs?

Taking appropriate steps at the time of, or as soon as possible after, a workplace accident will benefit all parties. Ensuring an injured worker receives beneficial and necessary medical treatment is of the utmost importance.

Additionally, taking swift action may allow employers and insurers to limit or lessen workers’ compensation exposure on a claim, as well as institute policies and changes to prevent future accidents and claims.

Ensure proper medical care is provided

Under many state workers’ compensation laws, which will vary based on statute language, employers are required to take steps to assist with the medical care of an employee hurt in the course of employment. Using Georgia law as an example pursuant to O.C.G.A. § 34-9-200, an employer is required to provide medical treatment likely to effect a cure, give relief or return an injured worker to suitable employment, as long as the treatment is causally related to the work injury. It is critical to help the employee gain access to emergency treatment if needed — doing so will not invalidate an employer’s posted panel of physicians. Once the employee has been discharged from the emergency room and received necessary treatment or testing, he can select a workers’ compensation medical provider who will be the authorized treating physician (ATP) from the employer’s panel of physicians. If emergency room treatment is not requested or necessary, non-emergency room treatment is always appropriate.

An employee who believes his employer cares about him is more likely to cooperate with medical treatment and efforts to return to work. Additionally, the earlier an injured worker receives medical treatment, the better the chances are he will recover from the work injuries. Unfortunately, a delay in receiving medical treatment can lengthen an injured worker’s recovery period. The employee will likely lose the desire to return to work the longer he is out, which can incentivize him to delay subjective recovery. These delays can also eliminate the efficacy of some treatments that may have been available sooner at considerable cost savings to the employer.

Request a drug or alcohol test ASAP

Using Georgia workers’ compensation law, as an example again, O.C.G.A. § 34-9-17 (b) details grounds for denial of compensation. According to the code section: “No compensation shall be allowed for an injury or death due to intoxication by alcohol or being under the influence of marijuana or a controlled substance.” Therefore, if intoxication is the suspected cause of an injured employee’s accident, obtain a drug or alcohol test from the employee quickly.

The code section further states there is a rebuttable presumption that an employee’s intoxication caused the accidental injury if “the amount of alcohol in the employee’s blood within three hours of the time of the alleged accident . . . is 0.08 grams or greater” or “any amount of marijuana or a controlled substance . . . is in the employee’s blood within eight hours of the time of the alleged accident.”

Given the importance of timing, requesting a drug/alcohol screen with the employee’s initial medical examination and treatment is a good practice. The code section also states that if an injured worker unjustifiably refuses testing, the employer/insurer has a rebuttable presumption that the intoxication caused the injury. The point of the rebuttable presumption is that the injured worker will have the burden of proving the intoxication did not cause the injury to overcome the presumption and receive workers’ compensation benefits.

Utilize employer’s posted panel of physicians

A posted panel of physicians can be an employer’s best friend in a workers’ compensation claim depending on their state’s laws. A valid panel satisfying all requirements in O.C.G.A. § 34-9-201 and board rule 201 allows the employer/insurer to provide a list of physicians from which the injured employee must select to treat his work injuries. This ensures the selection of doctors and/or facilities will be familiar with workers’ compensation procedures. It is important that these physicians are aware of and will treat the employees within the bounds of the state’s workers’ compensation fee schedule, which helps appropriately limit medical costs in workers’ compensation claims.

Ensuring an injured worker is made aware of the posted panel of physicians prior to and at the time of a work injury is vital. The employer can prove the employee was shown the panel and allowed to select a physician from the panel through many avenues, such as witness testimony or maintaining a signed copy of the panel in the employee’s personnel or workers’ compensation file.

Investigate accidents, preserve evidence

Investigating injuries when an accident occurs allows employers to determine the root cause and enact effective measures to avoid a recurrence. This should lead both to a reduction in accidents and to cost savings on the medical and wage benefit expense front. With proper investigation, employers and insurers can successfully manage legitimate claims and dispute illegitimate claims.

The injured worker and his supervisor(s) usually complete the necessary reports after a work injury is claimed, but the employer should also submit accurate reports to the insurer for effective claim handling. After report of an injury, an employer may seek out video footage showing where the alleged accident took place. To avoid recording over of the video and losing valuable evidence, identify and preserve the video as soon as possible.

Statements from the injured worker, witnesses, and the employee’s supervisors are helpful tools. Witnesses will have a more vivid recollection of important events soon after the event/accident. Preserve these statements by having them written and signed. In documenting the witness statements, obtain their name, addresses (physical, mailing and email, if possible) and phone number(s). This contact information, as well as the written and signed statements, could be critical later if employee witnesses are no longer employed by the employer when the claim is ready for hearing.

A quick, efficient investigation following an alleged work accident will help identify an employer/insurer’s potential defenses. These include, but are not limited to, defenses of notice, fighting, safety appliance violations, intoxication, traveling to and from work, etc. If any defense exists, knowing sooner than later allows an employer and insurer to appropriately deny a claim and prepare for litigation before expending costly benefits for an illegitimate claim.

Conclusion

Workers’ compensation insurance and administering claims is an important aspect of doing business. Accidents can and will happen in any work environment. Therefore, utilizing a valid posted panel of physicians, ensuring appropriate medical treatment is administered, completing drug/alcohol testing and properly investigating claims are all vital steps employers and insurers should take to help mitigate overall costs and diminish exposure in workers’ compensation claims.

Douglas W. Brown is a distinguished partner and firm leader with 25 years of service at Swift, Currie, McGhee & Hiers, LLP. His profession has been devoted to workers’ compensation law at Swift Currie, defending employers and self-insured businesses against workers’ compensation claims. He can be contacted at doug.brown@swiftcurrie.com.

Ann McElroy is a senior attorney at Swift, Currie, McGhee & Hiers, LLP, defending employers and insurers in workers’ compensation claims. Her clients include county governments, insurance companies and large-scale claims management companies, to name a few. She can be contacted at ann.mcelroy@swiftcurrie.com.

Opinions expressed here are the authors’ own.

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