Solving Problems With Workers' Compensation Claims

If you're a human resources professional, chances are you've had to deal with your fair share of workers' compensation claims.

Workers' compensation claims can be tricky to navigate, and it's important to make sure that you're handling them properly in order to avoid any legal troubles down the road. With that in mind, here are some helpful tips for solving problems with workers' compensation claims.

Communicate With The Employee

The first step in solving any problem is to communicate with the person who is experiencing the problem. This is especially true when it comes to workers' compensation claims. When an employee files a claim, make sure to reach out to them and ask for more information about the incident. This will help you get a better understanding of what happened and why the employee feels that they are entitled to workers' compensation benefits.

For example, a pharmacy benefit management company prizes communication between all parties throughout the life of the claim. This leads to reduced confusion and mitigates snags along the way. Lacking proper and consistent communication between parties is often a negative bellwether in any worker's compensation claims process.

Gather All Of The Necessary Documentation 

Once you have all of the information from the employee, it's time to start gathering documentation. This includes things like medical records, police reports (if applicable), and eyewitness statements. The more documentation you have, the easier it will be to make a determination as to whether or not the employee is eligible for workers' compensation benefits. 

When compiling documents, it's prudent to make use of a systematized process that applies to every claim and piece of paperwork. Automating these processes with the latest software solutions will help to keep the process running. The faster you can track and compile your documents, the easier the claim process will be both for your employees and the members of your team.

Work With The Employee's Medical Staff

If your employee has injuries, their medical staff will be a necessary outlet for gathering information about the employee's condition. Do not shy away from communicating early and often with the medical professionals that are nursing your employee.

The physician will often be able to provide you with information about the employee's prognosis and expected return-to-work date. This information will be helpful in determining whether the employee will be able to return to work and, if so, when.

Review The Workers' Compensation Policy Carefully

Your human resources policies are a driving force behind your business. This is especially true when it comes to workers' compensation claims. Familiarize yourself with the policy limits and exclusions. This will help you determine what benefits the employee is entitled to and how long they will be payable.

Make Use of Resources 

There are plenty of resources to help guide you through the claims process, so be sure to use them as needed. Some common outlets include entities such as state workers' compensation boards or insurance carriers' workers' compensation departments. These organizations can provide you with information about filing deadlines, benefit levels, etc. They can also help you resolve disputes that may arise during the claims process. 

Consult With A Workers' Compensation Attorney 

If you're still unsure as to whether or not the employee is eligible for benefits, your next step should be to consult with a workers' compensation attorney. They will be able to review all of the documentation and advise you on the best course of action. Keep in mind that it's always better to err on the side of caution when it comes to these sorts of claims, as there can be serious legal repercussions if you deny benefits to an eligible employee.

Make A Decision And Follow Through 

Once you've consulted with an attorney and gathered all of the necessary information, it's time to make a decision on whether or not to approve the workers' compensation claim. Once you've made your decision, make sure to follow through on it and keep the lines of communication open with the employee. If you deny their claim, be sure to explain why in a clear and concise manner. 

Workers' compensation claims can be tricky business, but if you follow these tips, you should be able to navigate them without any problems. Remember to communicate with the employee, gather all of the necessary documentation, consult with a workers' compensation attorney, and make a decision based on all of the information that you have gathered. Do all of this, and you'll be well on your way to successfully resolving any worker's compensation claim that comes your way.