1.  Report the Injury to the Employer

 

As soon as an industrial injury occurs, the employee must report the injury in writing to his employer.  The personnel office should have accident report forms available.

 

Once an injury is reported in writing, the employer will forward the First Report of Injury to the Workers’ Compensation insurer and the Department of Industrial Accidents (DIA).  The employer will be fined if it does not file the First Report of Injury with the DIA within seven calendar days of receipt.  The insurer has fourteen days from the receipt of the First Report of Injury to either commence payment of benefits or deny the case.  If the insurer fails to deny the case or commence payment within this time period, then escalating penalties may be imposed. 

 

• An insurer is more likely to voluntarily pay compensation in a case that is timely reported

 

2.  Timely Medical Treatment

 

After sustaining an industrial injury, the employee should obtain timely medical care and follow up with the prescribed treatment plan. 

 

• An insurer is more likely to voluntarily pay on a case when medical treatment is sought in close proximity to an injury.

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• In addition, the insurer is likely to closely scrutinize medical treatment close in time (either prior or subsequent) to the injury to ensure that the history in the medical records is consistent with the members’ allegations.

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• Anything reported to a medical provider during treatment will be documented in the medical records; therefore, it is important to convey a clear and consistent history when seeking medical care.

 

3.  Communication with the Insurer

 

After an industrial injury, the adjuster for the Workers’ Compensation insurer may try to contact the employee.  If the employee is represented by an attorney, then the member should not talk with the adjuster.  If not represented by counsel, it is up to the individual employee as to whether or not she chooses to speak with the adjuster.  Adjusters can be very aggressive and suspicious; therefore, they are often not pleasant to deal with.

 

• The employer/insurer may try to have the employee sign a medical release when he or she reports an injury.  Employees should be very careful when signing documents at the request of their employer/insurer.  Often a member will unknowingly sign a medical release, which allows the employer/insurer to obtain access to an employee's entire medical history.

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• When signing a release, the member should specify that he is only authorizing the release of records from places where treatment was rendered for the industrial injury.  In addition, he should indicate that the release only covers a specific time period.

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• The Workers’ Compensation insurer frequently hires investigators to provide surveillance of daily activities.  Be aware of unfamiliar faces in the neighborhood and strange phone calls.  Investigators often secretly videotape the movements of injured employees.

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• The Workers’ Compensation insurer has the right to have an injured worker examined by a medical professional at reasonable intervals, which is usually interpreted as being every six months.  Failure to attend this examination could result in the suspension of benefits.

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 4.  What to do if the Case is Denied?

 

If the insurer denies the claim, the employee has the right to file a claim at the DIA.  Once a claim is filed, the insurer has another fourteen-day period to either commence payment or deny the case.  If the case is denied, a conciliation will be scheduled at the DIA and the litigation process will commence.

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