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Jun 1, 2016

An Employer’s Guide For Accepting Or Denying A Work Injury Claim

Sponsored Content provided by Kara Gansmann - Attorney, Cranfill Sumner & Hartzog LLP

An employee’s claim of a work injury should set into motion a number of important considerations for an employer. The employer’s initial investigation of the alleged incident and claimed injury will play a key role in whether a workers’ compensation insurance carrier will deny or accept liability for a claim and, in turn, affect whether workers’ compensation benefits will be paid. These factors impact the workers’ compensation insurance premiums a business pays each year, so it makes sense for an employer to understand and help with the process. Here is a checklist for an employer’s investigation, record keeping, and response to a claim of a work injury:

  • Immediately determine whether the injured employee needs emergency medical treatment. If so, assist the injured employee in getting medical help by calling EMT personnel or arranging for transportation to an urgent care provider or emergency room. If emergency treatment is not needed, contact the workers’ compensation insurance carrier immediately and report the claim. The workers’ compensation insurance carrier should provide guidance on the steps to take moving forward.
  • Identify and record specific details about the alleged incident and injury, including how, when, where and why it happened. Unusual circumstances, such as whether the employee was performing his or her normal job duties and whether unexpected events were encountered, will factor into the decision of whether to accept or deny payment of workers’ compensation benefits. If there is surveillance video or pictures of the alleged injury or the events leading up to or following the incident, make sure this data is preserved for later review.
  • Record detailed statements from all available witnesses. Note with specificity any inconsistencies between the injured worker’s account of the incident versus other witnesses’ versions. An unwitnessed incident might factor into the denial of a claim, especially if there are disparities regarding how the injury occurred as the story is repeated.
  • Identify the specific individuals who first received notice of the employee’s injury and when the notice was provided. Most companies require an injured worker to immediately report a work injury after it occurs. The North Carolina Workers’ Compensation Act requires that employees provide written notice of a work injury within 30 days or they will need to show the employer had actual notice and was not prejudiced by the delay in receiving written notice. A long delay between the injury and when notice is first provided should raise red flags for an employer and an insurance carrier and might support the denial of payment of workers’ compensation benefits.
  • Maintain a specific file for each worker who asserts a claim and keep track of all crucial claim-related information. This file should include information about the alleged injury and what happened initially, as well as detailed job descriptions, offers of re-employment, rates of pay, dates of work and earnings prior to and after the injury, any notes from medical providers for work restrictions, and communications regarding the employee’s return to work and any accommodations that need to be made. These documents may be crucial if litigation becomes necessary to defend the denial of a claim.
Employers who follow these steps in responding to claims of injury help pave the way for a smoother process in either helping an injured worker return to work or litigating a denied claim.

Kara Gansmann, a North Carolina native, is an associate in Cranfill Sumner & Hartzog LLP’s Wilmington office, where she focuses her litigation and appellate practice on various aspects of labor and employment law, business and contractual disputes, medical malpractice, and HOA matters. To contact Kara Gansmann, call (910) 777-6055 or email her at [email protected]aw.com.
 

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