March 23rd, 2017

One of My Employees is Injured. What Do I Do?

Workers Comp 0

Employers of all industries and sizes face unique occupational hazards and varying levels of risk that their employees will experience an on-the-job injury.  Whether you are in a relatively low-risk industry or one that has a higher probability of injury, having an effective injury reporting process in place is critical to minimizing operational disruptions, as well as controlling workers’ compensation premium costs.

Medical Treatment Beyond First Aid?

The first step in the process is to determine whether or not the employee sought medical treatment beyond first aid.  A good guideline to use is to consider whether or not a medical bill was generated as a result of the incident.  In many incidents, employees will treat with basic first aid at the job site or workplace and not require further medical attention.  Examples of first aid provided on-site include:  cleaning of minor cuts, scrapes or scratches; applying bandages and dressings; and use of non-prescription medication.  In these cases, the employer is not required to file a workers’ compensation claim.  However, it is recommended to conduct an internal incident investigation, document your findings and maintain these records.  This is especially important considering that employees have two years to file a workers’ compensation claim in Ohio.  Without proper documentation, employers will have little to work with if the claim is in question.

My Employee Went to the Doctor…Now What?

If the employee sustained a more significant injury that does require medical treatment with an initial treating provider, then a First Report of Injury form (FROI) will need to be completed and returned to the workers’ compensation managed care organization (MCO).  In many cases, the treating physician submits this form to the MCO, although the employer or injured employee may do so, as well.  To help expedite the reporting process (and accuracy), it is recommended to provide employees injury reporting packets when they go to the doctor.  These packets may contain an MCO identification card that includes information about the employer and MCO needed to complete the FROI.

CareWorks clients have the ability to submit the FROI form either by fax, phone, email or through our online reporting system.  Once the MCO receives notification of an injury, it is filed electronically with BWC.  .  Once the claim is submitted to BWC, a claim number will be assigned and they will begin their process of review to determine claim allowance.  It is also recommended that the employer communicate with their TPA directly to expedite the claim management process.

 Why Does CareWorks Keep Calling Me?

There are several key pieces of information the Ohio Bureau of Workers’ Compensation requires MCOs to collect when submitting a claim.  Required data elements include:

Injured employee’s first and last name;

Injured employee’s address;

Date of injury;

Accident description;

Nature of injury;

Accident location;

Cause of the Injury;

Coverage code;

Claim indicator (i.e. Medical Only, Lost Time); and

Employer’s BWC policy number

Beyond this initial information needed to file a claim, BWC requires MCOs to obtain additional information such as employee’s marital status and dependents, date of hire, and county of operation among others after the claim has been filed.  CareWorks staff will reach out to the employer, injured employee and physician to gather this information and in some cases will require multiple calls if immediate response is not provided.  As we are collecting this information, the MCO is also evaluating the claim to determine the severity of the injury, review treatment options and return-to-work.

Having good injury reporting procedures in place is a crucial strategy to effective medical management, including expediting return-to-work and controlling workers’ compensation costs.  In fact, an analysis of CareWorks claims indicates that claims filed within one day of injury have 9% lower medical costs compared to those filed more than a week after the incident.  These cost savings are compounded when considering compensation costs and reserves.