Claim Reporting – Warnings and Guidelines


This is one of the most critical subjects you will ever try to understand about Workers Compensation. Yet, it is not a subject that screams out to you at the moment of your possibly fatal mistake; a mistake made all too often if using employer based logic.

Each state requires employers to report all injuries, which is tacitly defined as – every complaint, every whimper, every rumor, every hint, every expression of pain – in other words everything connected with a conveyed or perceived employee comment however timidly it may be expressed at the time. To NOT do so, and regardless of the break down within your organization is to deny the employee their legal rights. Sadly this violation begins at the very moment of awareness by you or anyone within your company. In the end – employers, supervisors and co–workers DO NOT have the right to decide what should be reported when it comes to an injury, and many times an employee complaint is not obvious or clearly defined.

Some states allow for “stress and psychic” claims that have ambiguous dates covering protracted time frames and when they hit trouble is most likely heading your way.

Some states will make you think you can decide to report or pay a claim directly as if it magically inoculates you and your future EXP MOD. And if you are one who loves to gamble on Work Comp maybe you will take the bait even if doing so proves to be a costly mistake down the road. States have been at this game far longer than you and the cards are stacked against you just like in Vegas. In other words, beating the house in Vegas is much like beating the system in Work Comp.

INSURED SOLUTIONS rule is to always – promptly report any injury and/or complaint by an employee, other than a band–aide cut and back to work. Complete the paperwork and submit it as a claim and/or mark it as an IRO (Incident Report Only).

The files outlined over the coming months in this newsletter are to reveal the potentially dangerous mine field for YOU as the employer just in case you like to gamble? In the end, the system is NOT your friend and does not represent your interests thus disliking or disagreeing with the claim reporting mandate is not relevant in the end since the system has the final say, not you or Insured Solutions.

Succeeding over time with Workers Compensation is learning to do the right thing regardless of your current opinion, and the right thing may at times be contrary to your beliefs or wishes.

Carefully review our subsequent Newsletters over the coming months beginning today so YOU can begin to protect your back pocket when it comes to controlling claim costs.

If you have questions please call our Risk Manager to discuss them. Do not guess or underestimate the problems that can easily arise from a mistaken belief, which when wrong…means we both lose in the end.


Part One

It is incumbent upon every employer to promptly report all injuries. Every state mandates this be done. Employers should not decide if an injury is reportable or not. Just report them to avoid legal pitfalls and the related problems that not reporting them will cause for you.

Cost containment in the end depends on prompt reporting as every state has built in cost increases for reporting delays – and sadly ONLY you the employer are penalized.

A claim’ cost rises by 40% if it takes more than 3 days to report the injury.

Legal control of a claim is typically waived if it takes 7 days or more to report the injury or what is deemed to be an injury as defined by the employee, not as defined by you.

Per State Laws – Only what the employee says is an injury actually matters. What you think or say as the employer is not relevant to the state or the Work Comp Board.

What does – Report all injuries actually mean to you – the employer

It should mean every employee injury or incident that is not a First Aid or band aid and back to work type of injury (i.e. cut) should be reported (including marking on the FROI if needed “incident only”) and especially every soft–tissue injury, which can go from Tylenol to surgery in the blink of an eye.

First Aid injuries are not reported but they should be logged on paper by name, type of injury, needed supplies, date and time. A written record can be important down the road.

Reporting all injuries also means for Refusal of Doctors Care situations. Why? First, it is still an injury; second, the employee has one year from the date of as said injury to receive full treatment for the injury plus you will be fully vaccinated regarding the 7–day reporting requirement noted above. Always send the FROI and the Refusal of Doctors Care form as soon as possible. The supporting Investigation Reports can follow if necessary as understandable delays can occur.

Reporting all injuries should also mean for any vehicle accident – be it to or from work (let the adjuster decide if valid), during the work day or, if deemed as related to work. Here an FROI should be submitted regardless of the stated injuries. In today’ litigious society there is a high probability the employee will find a trial lawyer no matter the current extent of the injuries. Yes, economic greed is alive and well especially when it comes time to buying a new “used” vehicle. Moreover, failure to report via an FROI in MVA situations can lead to serious Work Comp problems since auto–liability carriers will always avoid bodily injury payments asserting the individual (your employee) was injured in the course of employment thus making the costs applicable to Work Comp (YOU). Work Comp always pays medical expenses out of the gate including emergency care. However the carrier can only consider subrogation against the liability carrier of the party–at–fault if they know about the accident, which includes submitting a police report as soon as you can. Yes, it takes time to “maybe” clear up your Work Comp charge–back with NCCI on a vehicle accident but unless you report it promptly the time statute will expire and you will remain permanently responsible leaving you to watch your EXP MOD rise year after year. On this issue – do not decide on your own…just report all MVA situations.