ARI Blog: Article

Restoration Insurance: Avoiding Long-term Workers Comp Claims


Failing to pay adequate attention to an employee immediately after he or she is injured can quickly result in expensive, tough-to-close workers compensation cases for many restoration contractors.

Failing to assign adequate resources to a newly reported claim, or assuming such claims will be appropriately handled, often is cited by experienced risk managers and other workers comp professionals as the major reason why otherwise typical employee injury cases spiral into legacy claims that defy resolution. In fact, many of restoration companies largest claims start out as medical-only claims when they are first opened.

Medical-only claims result from injuries expected to require only limited medical attention without the employer having to pay indemnity benefits since the injured worker remains on the job while recuperating. You have to pay special attention to medical-only claims, though as they can quickly escalate into much larger claims.

Not acting immediately can push injured workers down a path that turns otherwise ordinary claims into larger problems.

Legitimately injured workers are often lost and possibly fearful of the workers comp system. Many simply don’t understand how workers comp operates, they may even fear that making a claim could cost them their job. For employees that are lost, the first thing they do is get an attorney and get a new doctor, or doctors, and get taken off work immediately. If they don’t hear from the employer, they are going to get a temporary total disability slip.

A claimant’s age; health conditions such as obesity, diabetes or heart problems; salary; and previous claims history are important factors to learn about early in the in a claim. Failing to get such information quickly diminishes the employer’s chances of properly managing the claim, he said.

For example, health conditions may indicate that the worker’s recovery will require managed care resources or nurse case management services as well as closer communications with the claims adjuster so the claim doesn’t turn sour.

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