Focus on HR - World Class Worker's Compensation - Part 2

By Hedley Lawson, Jr.
As with all two-part articles, beginning to read part two typically starts with having part one of the article handy. If you’ve located a copy, that’s great. If not, go to Take a moment to refresh yourself on the key points.

After reading part one, you’re probably saying, “That was very helpful information; however, we will inevitably have an accident or injury that results in a workers’ compensation claim. So how do we manage it effectively?”

Effective Accident Reduction Techniques

Over 90 percent of occupational accidents or injuries occur as a result of unsafe acts and work conditions. An unsafe act is any hazard created as a result of a human action or behavior, rather than defective equipment, materials or policies; and is normally outside of operating procedures and can be attributed to:

• Lack of adequate training

• Poor attitude

• Pressure to work faster

• Lack of proper equipment or tools

• Unclear operating safety policies or procedures

• Poor leadership

So to get you started, here are a few places to focus your assessment of unsafe acts and work conditions. First, to understand the objective of the work activity, you must observe it to identify inefficient actions or steps; and to be familiar with the standard or accepted practice for completing the task. Observe the attitudes of your employees, regardless of behavior because attitudes precede behavior, just as behavior precedes accidents. Second, identify symptoms versus causes. Symptoms are those unsafe acts and conditions that will ultimately result in an accident, including:

• Broken equipment

• Slick or messy floors

• Poor attitudes

Every symptom has one or more underlying root causes, including:

• Stress

• Improper eyeglasses

• Faulty brakes on a lift truck

• Ineffective equipment

maintenance • Supervisors who think safety is someone else’s job

Here are a few items to keep in mind as you begin your observation and assessment of work activities:

• Trust your initial impression. People begin to change when they know they are being observed.

• Know the safety track record of your lab. Know specifically what hazards to look for and know what behaviors tend to lead to those accidents.

• Document your observations and findings. Create an information and documentation trail for implementing change and for employee accountability.

• Take immediate action. Correct unsafe acts immediately and speak to all employees about any unsafe behaviors and sources of poor attitudes or morale.

Typical Injuries and Accidents “Arising in the Course of Employment” The most frequent cause of injuries to employees that “Arise in the course of employment” are:

One’s engagement in any activity related to employment

• Driving, such as special errands or business for which one would receive reimbursement of travel expenses (e.g., inside staff drive in the course of their work activities or as assigned by management, outside sales staff).

• Horseplay, including injuries suffered by innocent victims.

• Recreational and social events, such as lab-sponsored athletic teams and events during non-work and non-paid time (e.g., company holiday parties or celebrations).

The Flow of Claims Management and Your Investigation

Under the best of efforts by you and your employees, one of your employees promptly notifies you of an occupational accident or injury and you promptly file the claim with your workers’ compensation carrier. What action follows by your workers’ compensation carrier:

• Your claim report was accurate, complete and thorough

• The claim was filed on a timely basis

• You discussed with your carrier any potential problems or concerns

• You directed the injured employee (the claimant) to your authorized medical clinic for diagnosis and treatment

• You utilized only a pre-determined and authorized medical clinic with whom you have an established working relationship

• You discussed with the treating clinician the nature of the injury or accident, the facts and data you have gathered in order for the treating clinician to make an accurate medical assessment

• You also discussed a Return-to-Work strategy, if appropriate After assuring that your employee has been seen by an approved treating clinician and you have fully documented the claim for submission to the workers’ compensation carrier, you next need to conduct a thorough and complete investigation. Why?

• To factually evaluate and document all relevant details associated with the accident or injury

• To identify and eliminate hazards, and to understand why either a near-miss or accident occurred

• Provide visibility to your lab employees that safety is important to you

• To evaluate both supervisory, management and employee performance against your safety expectations and requirements

• To fulfill your legal requirements

• To develop defenses in the event legal action is brought against you

• To identify individual and group training needs

• To identify trends in the severity of accidents, injuries and work area safety performance

• To identify and control specific high-risk areas of your lab operations

Types of Investigations and Effective Investigation Procedures

Investigations need not only occur following an accident or injury. Effective investigations relating to your workplace safety fall into the following categories:

• Routine daily inspections, where supervisors, employees and maintenance staff ensure that housekeeping and equipment are in full compliance with your expectations

• Planned inspections, such as a scheduled management safety audit or “walk-through” by your Safety Team

• Unplanned inspections, where various members of your lab management staff assess safety practices as a part of their responsibilities and accountabilities

• Formal investigations following an accident or injury

Prior to any investigation, it pays to be prepared.

• Plan ahead. Have immediately available a writing pad, graph paper, a camera, a video recorder, and barricades. Train individuals who will be conducting investigations

• Care for the injured employee. Stabilize and care for the individual and prevent further injury or damage

• Preserve evidence. Secure the accident location

• Interview witnesses. Document all discussions and, if necessary, obtain a signed statement from employees

• Analyze information. Interpret the data and reconstruct the sequence of events. Determine the “Root Cause” and identify any inconsistencies

• Develop recommendations. Ensure judgments are based on verifiable evidence or on factual statements. Make recommendations which address “Root Causes”

• Complete your investigation report. Use factual information gathered to complete and submit your Report of First Injury or Accident with your workers’ compensation carrier and your authorized or approved medical provider

• Address necessary changes. Any changes necessary to mitigate a problem or hazard should be made and documented

• Conduct follow-up activities. These would include such items as training and changes in operating procedures. Determine what, if anything, should be done differently

• Access the quality of your investigation process.

Remember: Investigations are for the purpose of fact finding, not fault finding.

Effective Claims Management

Although claim reserves are set by your workers’ compensation carrier for each claim, you and your insurance broker should discus with the carrier the reserves that have been set and any events that you are aware of that would lead them to make any adjustment to the reserves, either higher or lower.

All too often, the one element of effect claims management (and effective employee relations) that is overlooked is the employee. Follow up frequently with our injured employee to determine the progress of their recovery and any necessary follow-on medical care or assessment and if and when they are returning to work -either without conditions, restrictions or modifications, or with modified duty. Not to be overlooked is your continued evaluation of medical management and medical efficiency in managing the medical aspects of the claim. In doing so, discuss with your authorized treating clinician the employee’s condition and progress, and any possible return-to-work or modified duty prospects, and agree to a plan of action.

With this information, keep your workers’ compensation carrier informed of any changes or potential problems. And lastly, monitor your action plan by focusing on aggressive resolutions and efficient closures to ensure all possible legal exposures are addressed.

Effective Return-to-Work and Modified Duty Programs

A study by the Menninger Institute noted that if a person does not return-to-work within 60-days, the likelihood of him/her ever returning falls of substantially. The employee actually begins to think of him/herself as disabled.

Effective return-to-work and modified duty programs are both offensive and defensive. These programs become a part of your lab philosophy and culture, reducing reduce your exposure to unnecessary claim costs (medical, compensatory, disability and vocational rehabilitation costs) and potential litigation. It improves communication between you and your employee, and employees stay connected to their colleagues and events at work. The longer an employee is out of work, the more difficult it is to return to work. A return-to-work program is ADA compliant and is proactive, plus it’s the right thing to do as an employer.

In conclusion, following the steps outlined in this two-part article, if fully and effectively implemented, will have a positive and lasting effect on your lab’s workers’ compensation program. Indeed, you will have implemented a “World-class Workers’ Compensation Program.”


Labtalk June 2020