Workers Comp: Use and Abuse

Suze · April 2003

Hello there,

Would anyone be willing to share a copy of their Workers Comp Policy and Procedure with me? I am part of a new HR team and we're trying to clean house and bring our agency up to minimum standards in tems of HR policies and procedures.

We have an employee who's been out on Workers Comp for over a year and the insurance company has already paid over $100,000. I'll have to admit that we don't have a good follow-up mechanism either, because this did not come to our attention until the insurance company paid us a visit and asked us to do something. Please help.

Suze

sonny · April 2003

[font size="1" color="#FF0000"]LAST EDITED ON 04-30-03 AT 10:27AM (CST)[/font][p]Am not sure why the insurance company is asking you to do something about it. .in my opinion they should be managing the case! In terms of policies, do you want to have a light duty program? Are you going to cover the first 7 days off? If you don't have one you will need a first report of injury form and define time frames within which it must be completed etc. Hopefully, others more worldly than I will jump in here.

Parabeagle · April 2003

What industry are you in? Are you a public or private employer? I assume from your post that you are not self-insured because you refer to an insurance company. I agree with the above, the insurance company should be proactively managing the claim (especially if they've paid out of $100K).

If you like, I have a binder provided to us by our carrier that covers light duty, reporting forms, light duty return-to-work job offers/agreements, etc. It's specific for Oregon law, but many of the forms and policies/procedures contained in it should translate well to what you want to accomplish. Just let me know.

Eliant · April 2003

unfortunately I'm not able to share this info. However, I will share with you the following. First determine the status of the case, why $100K? is he/she legally represented? get your W/C counsel to work on this if this peron is represented. If not, then get the carrier to set up some sort of examination (in california we have QME - Qualified Medical Examiner)this person is a neutral party who will review all previous medical including x-rays', MRI's etc then examines the person and deermines the factor of disability or incapacity, wether it be temporary or permanent. From there you and your carrier according to state law and company policies will determine what the final step will be.

As for helping you not get there, develop a policy were everyone from the top down is accountable. Sometimes OSHA themselves can help. They have consultants that can come and asess your place, give you guidelines. Another suggestion is the National Safety Counsel, J.J.Keller and Associates.

Ihope this will help.

Cindy Hanna · April 2003

I would not call OSHA to inspect. OSHA can and will fine you if they find something oyt of compliance. However, I would call the National Safety Council or The Safety Council in your state. They will come out and help you at no charge and they do not fine you unless they find a serious violation and you do nothing to fix it. The Safety Council will call OSHA on you. The Safety Council will also help you with any written programs you would like help with.

Hope this helps

sonny · April 2003

Actually, we used to call OSHA in every 3 years before our national accreditation. No charge and I believe they can not fine you if you request their consultation. Would not neccessarily use them here however.

Workers Comp: Use and Abuse

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