Management Roles and Responsibilities In A Workers Compensation Program

Employers who take control and direct the management of their workers compensation injury claims are most likely to see the best results in cost savings.

The personnel involved often include the workers compensation claim coordinator, the floor or field supervisors, mid-management, medical personnel, legal, senior management and even the employees.

Management Roles and Responsibilities

The most important role the employer plays is to know what these roles and responsibilities are and to assign them appropriately.

Begin by defining and writing down each participant’s role and duties, including pre-accident responsibilities and the post injury response.

By knowing what is expected of them, each person can take the appropriate action when an injury occurs.

Management will:

1. Provide a strong safety program and implement the necessary risk management practices to prevent workplace accidents/injuries in the first place and their subsequent workers compensation claims
2. Know the monthly and on-going cost of workers compensation losses.
3. Communicate to employees how many additional sales or additional production is necessary to cover the cost of workers compensation claims by using the “Sales to Pay for Accidents” Calculator.
4. Determine the medical providers to be used.
5. Determine the insurance carrier or the third party administrator
6. Track and report lost work days.

Claims Coordinator Responsibilities

The workers compensation claims coordinator, whether working full-time at a medium-size or large employer, or part-time at a smaller company, is the pivotal person in controlling workers compensation claims.

The claims coordinator can be part of the risk management department, finance, or human resources. The important thing is the claims coordinator has access to all information necessary to control the claim.

Claims Coordinator will:

1. Establish a transitional duty program prior to injuries occurring.
2. Provide all new hires and annually to current employees the employee brochure on what to do in case of an accident.
3. Arrange immediate medical care at the required or recommended medical provider. Nurse triage can be the initial step to ensure the appropriate level of medical care.
4. Provide the medical provider with a detailed job description prior to the employee arriving for initial medical treatment.
5. Interview the injured employee to obtain a detailed description of how the injury occurred.
6. Interview the employee’s supervisor to verify the description of the accident and what could have been done to prevent the accident.
7. Complete the first report of injury and give it to the claims office the day of the injury.
8. Contact the employee immediately following the initial medical treatment for diagnosis, prognosis, and expected period of disability, if any.
9. Arrange for transitional duty (light duty or modified duty) for the injured employee.
10. Send the employee a get well card while the employee is off work.
11. Maintain weekly telephone contact with the employee while off work and treating. Have a nurse case manager contact the employee after each scheduled medical visit. On-going contact with the injured employee allows for discovery of any problems – such as not keeping medical appointments or difficulty with healing or medications prescribed – before they get out of hand.
12. Facilitate on-going contact with the claims adjuster and the nurse case manager.
13. Coordinate and complete all necessary paper work related to the claim.

Supervisor Post-Accident Responsibilities

Supervisors have specific post-accident responsibilities to ensure injured employee receives the best medical possible.

Supervisors will:

1. Accompany the injured employee to the required or recommended medical provider.
2. Provide the medical provider with the Work Ability Form and obtain the completed form from the medical provider’s office. Require the employee to get this form completed during each medical visit.
3. Submit the appropriate forms to the workers compensation claims coordinator, such as — Work Ability Form, Supervisor’s Report of Injury, Employee Report of Injury, Witness Report Form.
4. Enforce compliance with the transitional duty program and verify the work done by employees on modified duty is in accordance with the medical provider’s limitations.
5. Train all employees in what to do when an injury occurs.

Employee Role and Responsibilities

Last, but equally important, every injured employee needs to be involved in the control of workers compensation claims. Employees have responsibilities too!

Employees will:

1. Participate in post-injury response training.
2. Participate in the return-to-work transitional duty program.
3. Attend all employee weekly meetings and/or office meetings unless physically unable to get to the work-site.
4. Provide the work ability form to the supervisor or claims coordinator after each doctor’s visit.

The above roles and responsibilities can be expanded to include risk managers, medical directors, in-house medical clinics, and in-house legal counsel and staff.

Workers Compensation Management Program – Reduce Cost 20% to 50% contains several detailed chapters on the material briefly outlined in this article.