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How to investigate employee’s work injury

Bill Oxford/Getty Images Workers' Compensation form with pen and glasses
INVESTIGATE: It is advised for employers to thoroughly investigate an injured employee’s claim as soon as possible.
There are two lists of questions to consider when an employee files a claim.

Employees who claim they suffered an injury while at work usually report the incident immediately. This prompts the employer to submit the worker’s claim to their insurance carrier or third-party administrator.

During this process, it is a best practice for employers to thoroughly investigate an injured employee’s claim as soon as possible. To conduct the most thorough investigation possible, the legal firm of Foster, Swift, Collins & Smith created two lists designed for employers, insurance adjusters and claims analysts to use.

Gathering information from workers

When gathering information from workers, here are some questions to ask:

  • What specifically is the worker alleging?
  • Was the injury witnessed and, if so, by whom?
  • When did the worker report the injury, and to whom did they report it?
  • Did the worker seek treatment?  If so when, where and with whom?
  • Did the worker continue to work after the injury? Did they finish their shift? Did they return the following day? When did they last work?
  • Does the worker have any current restrictions?
  • Was the worker working with any restrictions at the time of the alleged injury?
  • Has the worker ever had any prior injury to the affected body part or been treated for similar complaints?  If so, when were they treated and by whom?
  • What are the names of the worker’s current and past primary care physicians?
  • Did the worker have any other employment at the time of injury?
  • Has the worker made any claims for benefits against any other entities related to the alleged injury?
  • Is the worker collecting unemployment benefits or disability benefits through an insurance policy?
  • Does the worker have Medicaid?  Are they a Social Security disability recipient, or have they applied?  If so, when did they first begin receiving Social Security disability benefits?

Other information to document

Ask the following questions to document information after a worker reports an injury:

  • When was the worker hired?
  • Was the alleged injury witnessed? Are there any injury reports or witness statements?
  • Were there any cameras in the area that could have captured the event? If so, request copies of the footage.
  • Did the worker undergo a pre-employment physical?  Did they require regular certifications for fitness-for-duty?
  • What is the worker’s job description?
  • Did the worker ever complain of a work injury in the past?
  • Did the worker ever make similar complaints in the past?
  • Did the worker provide a restriction slip following the injury?
  • What was the worker's attendance record immediately before and after the time of injury? 
  • When did the worker last work? 
  • Are there any third parties potentially at fault or third-party claims that you are aware of?

These lists are not designed to be exhaustive. Supplement your own investigatory questions with questions from these lists.

Source: Foster, Swift, Collins & Smith, which is solely responsible for the information provided and is wholly owned by the source. Informa Business Media and all its subsidiaries are not responsible for any of the content contained in this information asset.
TAGS: Management
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