In worker's comp claims, information is key

Real Estate Weekly, June 16, 1993 by Barry Hartglass

When a worker's compensation accident occurs, it is important that an employer cooperate fully with his insurance company and assist the carrier in their investigation. Assistance should include conducting a preliminary investigation and completing the employer's first report of accident. The insurance company should be informed of any questionable, suspicious or unusual circumstances. Responses to requests from the insurance company should be prompt, as should those from the Worker's Compensation Board. Working closely with the insurance broker will help with any questions about the process.

A preliminary investigation includes speaking to the employee, co-workers, supervisor, and any witness regarding the incident. If possible, the accident site should be visited. Some employers find taking notes or a photograph helpful. The information obtained could be useful in the prevention of future similar accidents.

The Employers First Report Of Accident is a state-mandated form. In New York it is called C-2. It is recommended that the accident description begin with the word "alleged" or with the phrase "employee." An employer should attempt to identify the exact part of the body injured while refraining from a medical diagnosis.

If warranted, an employer should notify his insurance company of an unusual characteristics concerning the employee or incident in question. This is usually accomplished by a confidential letter, which is separate and distinct from the employer's first report of accident. Such information could contain:

*Reasons why it is felt that the alleged incidentor medical condition is not work related

*Prior accidents or pre-existing medical conditions

*Third party identification with respect to possible future subrogation

An insurance company may need to follow up. This may include telephone investigations, field investigations, depositions, and requests for payroll information.

Usually requests made by the State Worker's Compensation Board should be referred to the insurance company for a response. These requests are usually for copies of forms or for testimony at a hearing.

An insurance broker usually serves as a liaison between an employer and its carrier. The broker can advise the employer and monitor the insurance company's activities.

The timely, and efficient handling by all interested parties of a worker's compensation claim will ensure a prompt finalization. It will fulfill State statutory requirements and if a claim is to be contested it ill be apparent immediately. If not, the injured employee will receive the proper payment of benefits. This results in a positive effect on employer/employee relations. Employees will return to work more quickly and there is ultimately less disruption in the work place. With all of the above taken into consideration, costs will be contained, which is in the best interests of everyone.