Most Pennsylvania employers are required to purchase workers’ compensation insurance. workers’ compensation insurance exists so that employees who are ill or injured in on-the-job have medical coverage and income protection during their period of injury, recovery, or disability. In turn, compliant employers have limits on exposure to liability for said work-related illness and injury. Employers can have a great impact in avoiding injuries through safety policies and practices and encouraging a healthy workforce.
Despite best efforts, however, accidents can occur, and the more physical the job, the more chance of an accident. Employers often check out of the process once they submit a claim to the carrier. This article calls on employers to stay engaged and resist the urge to hand off the hot potato to the workers’ compensation carrier until the employee returns or you are advised that he or she will not return. Here are some practices and policies that will improve the opportunity for a positive outcome in the event of a workers’ compensation claim.
- Your Panel: Take an active role in developing your panel. You will most times have information about local hospitals, specialists, and clinics that can inform the build-out of your panel and assist the carrier in making sure that you have the best and most effective medical care for your employees.
Consider using an urgent care clinic as a triage for all non-emergent illnesses and injuries so that you have a point person to manage the care and see employees quickly.
Make sure you can address minor first aid issues on site, as well as have access to life-saving training and devices such as an AED.
- Engagement: Studies indicate that keeping employees engaged during leave is essential to a successful return. So, call to check in and have supervisors send work updates and communications that the rest of the employees are getting. The Pandemic made Zoom/Teams and other online meeting platforms the norm, so use them to include your injured workers.
Make sure employees are heard and informed. Make sure the employees, witnesses, and supervisors complete injury and accident reports that document the incident contemporaneous with the occurrence and then discuss with the employee what happened. Ask the employee what changes he or she thinks could have prevented the accident. Reserve discipline for flagrant safety violations.
Explain the workers’ compensation process to an injured employee. Employees need to know what to expect. Fear and anxiety about losing a job can cause an employee to become antagonistic in the process instead of a partner returning to the job.
Talk to your carrier, get input, and advice, and take advantage of training for supervisors and employees. Larger employers may want to look into a third party as a liaison between the employer and the adjuster.
- Modified Work: Your carrier will want you to bring an employee back to work as soon as possible. Don’t be rushed in offering modified duty. Modified assignments should be actual, available work that meets the employee’s restrictions as directed by the treating physician. This work should be short-term, tracked specifically, and should be adjusted based on the addition, or deletion of restrictions.
Make sure you have ADA-compliant job descriptions.
Work with the carrier to ensure that communications with treating providers result in clear descriptions of restrictions that are directly related to the employee’s job. Sometimes forming letters with reference to a job description can be helpful.
Create a modified duty policy for all ill, injured, or disabled employees (not just work-related injuries). This will ensure a uniform, consistent and compliant distribution of available work assignments.
Understand the intersection between the workers’ compensation requirements, FMLA, if applicable, short term disability insurance, and the Americans with Disabilities Act.
- Make Use of the 90-Day Window:
Employees must treat by the employer’s panel physicians during the first 90 days of the injury. You should be aggressive in following employee treatment during this time frame so that you can understand the injury, restrictions, and treatment plan before the employee has the option of moving to other providers outside of your panel.
Don’t be a bystander in the Workers’ Compensation process. You have invested in employee training. Invest in getting them back to work.
If this happens, contact a Pittsburgh workers’ compensation lawsuit defense attorney at Neva Stotler Law. Hiring a qualified lawyer can play a significant role in your case’s outcome.
Reasons an Employee May Not Deserve Workers’ Compensation Benefits in Pennsylvania
The fact that an employee filed a claim to recover workers’ compensation benefits doesn’t always mean they deserve to collect them. The following are noteworthy examples of reasons an employer or insurer might have for denying a claim:
- An employee is seeking workers’ compensation benefits despite being injured outside of work
- An employee is fabricating or exaggerating their injuries
- A new employee was injured before starting work, but it now pretending they sustained their injuries during work hours
- An employee intentionally caused their own injuries in hopes of a payout
You’re likely an honest employer who genuinely wants your employees to recover workers’ compensation benefits when they’re legitimately eligible to do so. That said, you don’t need to allow some workers to take advantage of the system.
The Potential Consequences of Losing a Workers’ Compensation Lawsuit in Pittsburgh
When you deny an employee’s claim for workers’ compensation benefits, they may file a lawsuit in response. Don’t hesitate to reach out to a Pittsburgh workers’ compensation attorney in these circumstances. Potential consequences of losing your case include (but aren’t limited to):
- Rising insurance costs
- Damage to your reputation
- Becoming the target of future fraudulent claims and lawsuits, as some employees may now assume they don’t need to present a strong case to demonstrate that they should recover workers’ compensation benefits
How a Pittsburgh Workers’ Compensation Lawsuit Defense Lawyer Helps
Losing a case when an employee files a workers’ compensation lawsuit can jeopardize your company’s future. This isn’t meant to frighten you. It’s meant to encourage you to seek the assistance of a legal professional who can help you navigate this situation.
The experts at a Pittsburgh workers’ compensation lawsuit defense firm can improve your chances of winning a case (and make your life easier) by:
- Conducting an investigation and gathering evidence showing you had a valid reason to deny an employee’s claim
- Handling all correspondence with the plaintiff and their attorneys, preventing you from accidentally making statements that could negatively influence your case’s outcome
- Allowing you to focus on running your company while your case plays out
Contact a Pittsburgh Workers’ Compensation Lawsuit Defense Attorney
At Neva Stotler Law, we know some employees try to “game the system” by filing claims for workers’ compensation benefits they don’t deserve. If you respond to attempted fraud by denying a claim, a Pittsburgh workers’ compensation lawsuit defense attorney can assist you should an employee take legal action. Learn more by contacting us online today or calling us at 724-841-5565.