Injury Management

Workman’s compensation claims can put a company out of business if not taken seriously. While prevention is the preferred method of dealing with potential employee injuries, unfortunately, such injuries do occur and must be dealt with in some fashion. Getting injured employees proper, timely medical care, so that they can return to work quickly, is a key factor in keeping workman’s compensation premiums within reason. Not paying attention to what is happening can prove disastrous in the form of increased premiums, decreased productivity in your work force, and a negative effect on your profits. Assuming that the insurance company will “take care of it” is archaic and implies ignorance of the facts surrounding injury management. And, make no mistake – it should be viewed as injury “management” as you can manage the process of getting an employee the proper care in an effort to return that employee to an active work capacity. This doesn’t mean that companies should take a callous attitude towards good medical attention for an injured employee. However, not paying attention to the proper aftercare may promote abuses to the system and, therefore, dramatically escalate the costs associated with such insurance coverage.

When an employee is injured in any way while on the job, a report of the circumstances surrounding the injury should be generated. Even minor injuries may balloon into a major medical crisis if not treated properly. If an employee fails to report such an injury, and if no one at your company is aware of the incident, it can cause procedural problems later on. One person, an “Injury Manager,” if you will, should be in charge of documenting and following the injury from initial report to final disposition. All communication, documentation and information should flow through this one person so that nothing is lost. This includes proper, regular ongoing communication with the injured employee, the claims adjuster in charge of the case, the medical professional and the company itself.

Having a “Panel of Providers” is also essential to the entire process. Employees are notified when hired that there is an approved panel of medical providers that they are to see in the event of a work-related injury. While insurance carriers have a recommended panel of physicians, hospitals and medical facilities with which they work well, the insured (your company) should be able to have input into what doctors/facilities are listed on the panel. (Please note: from a legal standpoint some states do not allow employers to direct injured employees to specific medical facilities. Check your specific state’s laws.) These providers have the same goal as the company — to be certain that the employee receives the proper care and treatment as well as to get him or her back to work as soon as possible after recovery.

Should the work related injury require hospital or medical attention, the person in charge of injury management has the right and should accompany the employee to (or meet at) the doctor’s office, hospital or medical facility. Some companies will insist that the Injury

Manager be with the injured employee as soon as physically possible after the injury occurs, and then stay with the injured employee through the first hours of treatment, whether it is at a doctor’s office, the hospital or the physical rehabilitation center. Often, the injury is such (a non-emergency) that it can be treated in a doctor’s office instead of a hospital, thus saving considerable dollars for the company or the insurance carrier. A good Injury Manager can assist in this initial determination. Once at the doctor’s office (or hospital outpatient facility), should the medical professional decide that additional treatment is necessary, the injured employee and the Injury Manager can be transported to the recommended facility. The Injury Manager should then communicate with the doctor in charge so as to ascertain what additional immediate treatment is needed (if necessary) as well as what aftercare may be required.

Unfortunately, some injured employees may not adhere to the prescribed follow-up procedures and/or appointments, causing inadequate or insufficient attention to proper ongoing care. The Injury Manager should stay on top of the situation by communicating with the injured employee regularly. In some cases, it is advisable for the Injury Manager to accompany the employee to the aftercare doctors’ visits to ensure that the employee is adhering to the proper care program. Keep in mind that (essentially) you are footing the bill for the employee’s care through your insurance premiums, thus necessitating your participation in getting the employee ‘healed’ and able to return to work. At these aftercare visits, the Injury Manager has the right to talk with the physician to ascertain what is needed in order to assist with the recuperating process. Often, the Case Manager from the insurance carrier will also attend these appointments to keep accurate records of the entire process. Good communication is a key element in getting the employee back to work as soon as possible.

Part of the injury management process is to have a “light duty” work program in place so that the injured employee can go back to work, earn a paycheck and feel productive. Additionally, the Injury Manager can oversee the remainder of the recuperation process. Sometimes this light duty work schedule must be tailored to the individual employee’s immediate injury needs, however prior extensive studies show that getting them back to work is much more advisable than allowing the injured employee to sit around doing nothing productive. Interestingly, it’s been proven that performing light duty work often accelerates the desire to return to regular work status and positively affects the recuperation process.

As noted several times in this, and many other Safetyscapes articles, communication is a major factor in successfully returning the injured employee to full-time, full-duty work status. Communicate with the employee immediately after the injury occurs. Communicate with the medical professional to determine a proper care and light duty work regime. Communicate with the insurance company’s injury management specialists so that they don’t just keep writing out checks to the employee, when in fact, the employee is medically able and ready to return to work. Continue to communicate with the injured employee so that he or she knows you care and that the company is concerned that proper care is being given by the medical professional, and so that you can keep tabs on progress with the recuperation process.

This information is brought to you as an ALCA service by the Education Committee. If you would like additional information on the educational opportunities offered through ALCA,  please contact Elise Lindsey, Education Committee Liaison at 800-395-2522 or by e-mail at [email protected].