Each new year provides a fresh start and gives us an opportunity to think about how we want to change our behaviors or processes. We reflect on the past year and make goals for the coming year.
This year, consider reviewing your approach to claims at your company. An employer’s level of involvement throughout the claims process can have a significant impact on the course of a claim and its ultimate resolution.
Here are three claims resolutions to consider for 2020.
1. Resolve to create or bolster your current transitional work program.
We’ve explained in a past Longshore Insider article about the benefits of transitional duty. The new year is a great time to begin a transitional duty program. Do you have jobs that can be accomplished with restricted movement or restricted weight lifting? Management can brainstorm for opportunities on the job site for workers who have temporary restrictions. A vocational or ergonomic expert can be a resource to evaluate these jobs.
The new year can also be a good time to review and analyze an existing transitional duty program. Some questions you may ask are: Are you providing job offers in writing? Is the job description clearly articulated? Is the adjuster aware of the options available for temporarily restricted workers? How much does the light duty job pay? Is it a full-time position?
A well thought-out transitional duty program can lead to reduced claims costs and a more effective workforce.
2. Resolve to report injuries in a timely manner.
Timely reporting is a key component to your overall claims strategy. The sooner a claim is reported, the sooner the injured worker can receive quality medical care. The sooner the injured worker can receive quality medical care, the sooner the injury can resolve. The sooner the injury resolves, the sooner the injured worker can return to work.
Untimely reporting can result in the injured worker not receiving quality and appropriate medical care. This can lead to longer recovery and additional disability compensation. In addition, untimely reporting can lead to the injured worker seeking assistance from an attorney, which can result in unnecessary litigation expenses.
Finally, untimely reporting can result in stiff penalties. The Longshore and Harbor Workers' Compensation Act (LHWCA, or Longshore Act) requires lost time claims to be reported to the U.S. Department of Labor (DOL) within 10 days of the injury. Penalties can be assessed against employers that do not adhere to timely reporting. According to 20 C.F.R. § 702.204:
Any employer, insurance carrier, or self-insured employer who knowingly and willfully fails or refuses to send any report required by § 702.201, or who knowingly or willfully makes a false statement or misrepresentation in any report, shall be subject to a civil penalty not to exceed $24,017 for each such failure, refusal, false statement, or misrepresentation for which penalties are assessed after January 23, 2019. The district director has the authority and responsibility for assessing a civil penalty under this section.
3. Resolve to provide accurate and useful information.
First reports of injury provide key information that can determine the outcome of a claim. Reporting an accurate injury location and occupation can help establish the correct jurisdiction from the outset. For longshore (USL&H) claims, it is vital to indicate whether the accident was in maritime employment and whether it occurred upon or in an area adjoining navigable waters. Many disputes regarding jurisdiction and benefit entitlement can be avoided when the proper information is provided at the outset of the claim.
Other information that can be useful for effective claim resolution are wage records, work history, current address, marital status, number of dependents, child support liens or other wage garnishments and claims history. Complete and accurate records will assist in establishing the reserves and determining resolution strategy.
David Widener joined AEU in 2019 as Director of Claims Advisory Services. Widener began his longshore career in 2003 with F.A. Richard/American Equity Risk Services, where he was a claims supervisor for eight years. He joined the U.S. Department of Labor as a claims examiner in 2011, and was promoted to District Director six months later, overseeing operations for the Houston District Office. David has a B.S. in finance from Louisiana State University and is a credentialed mediator for the state of Texas.