Every year, worker's compensation claims cost insurance companies billions of dollars in policy benefits. With hundreds of thousands of claims being filed, it's tough to spot the ones that aren't necessarily legitimate. There are some things you should know as a business owner to help ensure the accuracy and legitimacy of every worker's compensation claim filed on your company's policy.
Training and Education Are Essential
Educating your staff and your management team about general safety requirements is one of the first steps toward protecting your company from fraudulent worker's compensation claims. Ensure that every staff member is trained on general safety procedures as well as any specific safety considerations for their particular positions.
You also want to make an effort to explain what the claims process is and what makes a claim ineligible, fraudulent or abusive. This information can help to prevent inadvertent issues because of employee misunderstandings. You should also make the point to tell your employees that there's a process established for validating the legitimacy and accuracy of claims. Don't give them the details, because that makes it easy to circumvent the system.
Managers Need a Solid Response Procedure
Setting up a solid procedure for your managers and supervisors to follow when taking claim reports helps to ensure consistency in the evaluation and handling of reports. Your first-line managers and shift supervisors are often among the first to know about injuries on the job, so they are one of your best lines of defense against worker's compensation fraud.
You should craft a list of questions designed to clarify the details of the incident so that you get a solid baseline of information right from the start. In addition, these details are important in the early stages, because they'll help you to identify fraud if the finer details change along the way. You should also find out what your worker's compensation insurance company needs to know about every incident and make sure that your questions address these things too.
The Insurance Company Needs Immediate Notification
When you're notified of any kind of workplace incident, you should notify your representative at the insurance company that holds your worker's compensation policy. This is important, because it permits them the opportunity to start researching and investigating the claim while you're sorting out the details. In addition, the sooner you notify the insurance company, the sooner your employee will be able to resolve the situation and seek payment for their injuries.
Every Injury Report Should Be Investigated
You shouldn't accept any injury claim as automatically accurate. Make sure that your first line management staff understands that each claim needs to be investigated as part of the processing. The point isn't to prove the injury claim false but to ensure that all of the details are clear. Record any witness statements when possible and get copies of any surveillance footage from the scene.
Make sure that extra attention is paid to injuries that occur early on a Monday or immediately after an employee returns from a vacation. You'll also want to be cautious about any injury reported with no witnesses to corroborate the story. You may find that the injury actually occurred before the employee came back to work or over the weekend. Your worker's compensation company can help you explore ways to identify issues like this.
Most insurance companies will send a fraud specialist out to evaluate claims if you ask for it. This is an important consideration if you have any suspicion that the claim isn't accurate. Fraud investigators are trained to detect things that you may otherwise overlook, so don't dismiss the benefit of requesting one for peace of mind. Preventing worker's compensation fraud is an important step in preserving worker's compensation insurance for all of your employees, so work closely with your insurance company to follow the tips presented here. You may also want to work with an experienced workers compensation attorney for more tips and advise. They can advise your company on how to handle cases that are filed by employees.