7 Steps to Safeguard Employees and Manage The Risk Of California Workers Compensation Claims

There are several things an employer can do to safeguard employees and manage the risk of California Workers Compensation claims. These are:


Reducing the frequency of your claims begins with hiring the right people for the jobs and duties they perform. Assuring that you are hiring an “A” player will not only improve the productivity and efficiency of your company, but may decrease your workers’ comp costs. Prospective employees that have a history of “job hopping” and short-term employment relationships may also have a history of California Workers Compensation claims. People who have filed fraudulent California Workers Comp claims are often characterized as “quitting” their job, followed by periods of non-employment. Although you may not discriminate against an applicant on the basis of filing a California Workers Comp claim, employers should look out for applicants with a spotty job record. Do your homework on each and every applicant, diligently confirming employment dates and reasons they left their jobs. Also remember to do the following:

Conduct a thorough background check (Research gaps and transitions in employment)
Require a pre-employment physical when appropriate (Typically, there must be a relevant and bona-fide occupational qualification for the testing).
Institute a pre-employment drug testing program.

Employees must constantly be made aware of the hazards that in the workplace and their potential consequences. Ill-informed or untrained workers can be contributing factors to occupational injuries. Although California Workers Comp is a no-fault insurance (the insured may pay regardless of who is at fault), many employees caught in accidents can blame their lack of knowledge or training as a contributing factor. To improve safety in the workplace, managers must initially and periodically train employees on proper safety techniques and practices.

Incorporating the training of specific procedures and responsible work practices is an ongoing responsibility. Close the skills gap and keep safe work practices at the “top of mind” for employees. Many safety-conscious employers that I have inspected have large signs that display the number of days since a loss-time injury. Many other successful safety managers have a safety-conscious award that they use to promote individuals “caught in the act” of taking the extra time to following safety procedures. Also follow these best practices:

Keep your Injury and Illness Prevention Plan (IIPP) up to date.
Your employee handbooks should require immediate notification of any injury.
Hold safety training meetings on a monthly basis (especially to avoid common injuries at your workplace).
Conduct periodic inspections.
Abate hazards to avoid injury (document in your IIPP binder).
Offer group and individual incentives for safety-conscious employees.

Offering medical insurance and retirement benefits provides employees with a higher quality of life. Employees who are uninsured often turn to workers’ compensation insurers to pick up the bill when it comes to “Monday morning” minor strains and sprains, the most common of all injuries. When faced with hefty bills, employees may file fraudulent claims to California workers’ compensation insurance carriers rather than purchase health care out of pocket.

Providing health insurance may afford companies special discounts of 5 to 10% off annual health insurance premiums to help offset the cost of benefits when combined with Workers Comp. Workers Compensation insurers have a strong motivation to reward you; their exposure to fraudulent and non-occupational claims decreases significantly when employees have coverage elsewhere. For example, a joint partnership with Blue Cross of CA and Fremont Insurance may provide a 10% credit to your Workers Compensation premiums in their preferred provider network program. Qualifications apply, so check with your broker.

Another occupational benefit is the implementation of an early return to work program. This program gives employee’s modified duty when recovering from an injury. Implementation of a program will decrease the cost of indemnity payments (lost wages) to the insurer, thus lowering the overall cost of the claim. Another benefit of this program is the continued engagement of the employee. When employees are fully engaged in their work, they are less likely to consider alternatives to resolving their claims of Workers Compensation. With the proper amount of time, rehabilitation, and care, your employee will back to work.


Employees injured on the job often feel apologetic about the damage they have done. Some even feel guilty for tarnishing the company’s safety record or reputation. In any case, don’t let your employee feel alienated or rejected in the wake of an injury. That emotional separation from the employer commonly fuels employee decisions to hire an attorney or get legal advice regarding their claim. When workers’ comp claims are litigated, the cost of claims generally rises. This can affect the loss experience of your company and lead to increases in loss reserves and even your experience modification factor.

Take care of your employees and tend to their every need, especially when a workplace injury occurs. Employees who have been treated fairly rarely see the need to sue their employer for benefits from workers’ compensation insurance claims. Follow these steps:

Is the employee is OK.
Does the employee feels safe.
Does he or she feel discomfort or pain?
Use a fitness for duty test.
Avoid “alienating” employees; spend time caring.
In the event of an emergency, take employee to medical provider of choice.
In the event of an emergency, obtain access to medical records.
In the event of an emergency, correspond with their physician.

Whenever an injury occurs, your government-mandated injury and illness prevention plan (IIPP) requires you to launch an investigation of the accident. Take copious notes and pictures, if possible. Obtain facts about the events and detailed descriptions of the physical characteristics of the claimants, machinery, equipment, facilities, conditions and environment. Ask witnesses to describe the accident in detail and to sign off on their statements. Thorough investigation records that are accurate and timely provide incredible insight into the claim. When a litigated claim finally goes to court or appeal, 18 to 24 months may have passed. Without a detailed description documented on paper, what the employee/claimant says might prevail. Keeping good records can help minimize the cost of the claim. Always remember to:

Take thorough witness statements.
Survey the work area and conditions.
Take photographs of the work area (if possible).
Maintain investigation records in your IIPP.
Update your OSHA 300 log (repeating injury).

Claims that are not closed in a timely manner increase your experience modification factor and, thus, your California workers’ compensation premiums. By staying in touch with the medical provider (ideally an industrial medical clinic), employees, and other parties, you can help close out claims and keep your experience low. After a claim is reported to your workers’ compensation CA insurance carrier, a loss-reserve is set aside on your policy based on anticipated future costs to return the employee to work. Such expenses may include medical costs, indemnity payments (lost wages due to injury), vocational rehabilitation, and temporary or permanent disability.

Once a year, your California workers’ compensation carrier sends a report card to the government agency that calculates your experience modification factor for the upcoming policy year. The “Unit Statistical Report” provides workers’ comp bureaus with information both on premiums paid, and losses incurred as a result of injuries. If you have open claims during the time that your unit statistical report is calculated, your experience modification factor may be overstated. Always remember to:

Maintain a good relationship with injured employees.
Report the claim in a timely fashion.
Obtain and audit provider invoices.
Correspond with claims adjuster; Keep a file.
Take steps to close claims.

Be sure to request a copy of your experience modification (often referred to as your “ex-mod”) worksheet from your state workers’ compensation bureau. This document provides the calculation and factors involved in the development of your mod. Businesses are often overcharged on workers’ compensation insurance premiums due to inaccurately calculated experience modification factors. Another report you should request is your loss run report. This report from your carrier provides you with an accounting of your paid-in premium and your open and closed claims by policy year. Review any open claims and examine any outstanding loss reserves. Be aware that the unit statistical report is sent out 6 months before the NAD

Know that the calculation date is 2 months before the NAD.
Request copy of loss runs, unit stat and experience mod worksheet from carrier.
Take the initiative: In California, you can dispute your experience mod factor!

Like many issues that plague businesses today, there is only so much that you can control regarding your costs for Workers Compensation coverage. Failed and insolvent insurance carriers have left the few players in the market holding the seller’s market hostage due to limited underwriting capacity. The underlying imperative to prudent businesses is to manage your controllable costs or hire a firm that with a comprehensive soup-to-nuts solution. In the end, you will find that a concerted approach with your management team, outside resources, and willing employees will be just the ticket to lowering your California Workers Comp premiums. A good insurance broker will help you implement all of the above mentioned suggestions at little or no cost.

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The 15 Costly Mistakes That Could Ruin Your Workers’ Compensation Claim

During more that 30 years of helping injured workers collect full workers’ compensation benefits, I have seen others make common mistakes that cost them a lot of money.

I discuss 15 of these errors below.

By recognizing and avoiding these common errors, I am confident that you will be in a better position to collect more money for your claim.

To help you avoid these mistakes, I have categorized the 15 most common mistakes and present them to you.

I am confident that after reading this article, you will have a better chance of collecting full payment for your workman’s compensation claim.

1. Failure to Report the Accident to Your Employer.

North Carolina law requires that a claim be reported to your employer in writing within 30 days from the date of the injury. Although in most cases you could proceed with your claim even if you do not file a written report in 30 days, these reports should be filed in writing immediately

2. Failure to File a Claim with the Industrial Commission.

North Carolina law requires that a claim be filed with the North Carolina Industrial Commission within two years from the date of the accident. In the case of occupational diseases, the claim must be filed within two years from the date the worker became unable to work With respect to occupational diseases, the filing requirements vary. Unless your employer has agreed in writing to be responsible for your workers’ compensation claim, you are at risk if you fail to file a written claim with the Industrial Commission within two years.

3. Failure to Inform the Doctor of the Details of Your Accident.

If your medical records do not reflect the fact that you have been in an accident, your claim may be suspect. Insurance companies use any excuse they can find to deny your claim. The absence of any information in your medical records about your accident may give them the excuse they want

4. Failure to Keep a Job Search Log.

The worker has the burden of proving that they are unable to work as a result of a workers’ compensation injury or occupational disease. One of the best ways to prove that you cannot work is to show that you have honestly tried to work but were unable to find and maintain a job.

5. Failure to Fully Inform Your Lawyer of All Facts.

Workers’ compensation cases are difficult enough to handle successfully, even when a lawyer has all the facts. If you do not fully inform your lawyer concerning all facts, the good, the bad and the ugly, you severely handicap your lawyer’s ability to win the case for you. Many facts which you may feel to be adverse can be successfully handled. Do not short change yourself by keeping your lawyer in the dark.

6. Failure to Fully Cooperate with All Vocational Rehabilitation Efforts.

The point at which the insurance company hires a vocational rehabilitation specialist to actively become involved in trying to find a job for you is probably the most critical point in the claims process. You should not attempt to deal with the rehabilitation process without the assistance of an experienced workers’ compensation lawyer. Vocational rehabilitation counselors, in the vast majority of cases, are not on your side. It is their job to terminate your benefits, either by your becoming employed or by taking advantage of your failure to cooperate, thereby have your benefits terminated. It is in your best interests to return to work at suitable employment. You should, therefore, fully cooperate with all reasonable vocational rehabilitation efforts.

7. Failure to Accept Suitable Employment.

It is in your best interest to accept suitable employment whether at your prior job or at a new job that may be presented to you. The law does not (and should not) allow a worker to collect workers’ compensation benefits if they can work. On the other hand, you are not required to accept any job that your employer or their vocational rehabilitation worker finds for you. The work must be “suitable” to you based upon your physical limitations, age, education, training, and experience. It is important to work closely with an experienced workers’ compensation lawyer to help you determine whether any job offered to you is suitable

8. Failure to Anticipate That You Will Be Followed and Videotaped.

It is a mistake to assume that you will not be followed and videotaped by private investigators. Insurance companies would rather pay money to private investigators and lawyers than pay it to you. You should assume that a private investigator will be watching your every move outside of your home. They may even look inside your home.

9. Working outside Restrictions When You Return to Work.

If a doctor allows you to return to work but conditions your return to work on certain restrictions such as not lifting above a certain weight, or raising your arms above your head, you should follow these restrictions explicitly. When you return to work, there is a temptation to follow your supervisor’s instructions even if those instructions would have you working in excess of the limitations your doctor imposes upon you. This is a serious mistake. Carry the doctor’s written restrictions with you when you return to work and, if your supervisor tries to coerce you into working outside of those restrictions, give another copy of those restrictions to your immediate supervisor and politely tell that supervisor that your doctor will not allow you to work outside those restrictions

10. Settling Your Claim without the Benefit of an Experienced Workers’ Compensation Lawyer.

It is a serious mistake to assume that your employer and its insurance company will treat you fairly. You should understand that in the vast majority of the cases, they will take advantage of you if you let them. Your employer and its’ workers’ compensation insurance company have on their side professionals who thoroughly know North Carolina workman’s compensation law. They are looking after themselves, not you. Always seek the advice of an experienced workers’ compensation lawyer before you sign any agreements.

11. To Assume That Rehabilitation Counselors Are Your Friend.

Rehabilitation counselors are working for your employer and the insurance company. They are not working for you.

12. Allowing the Employer to “Doctor Shop”.

If your employer accepts your claim and agrees to pay, they do have a right to direct your medical care. However, once your medical providers have been established, they cannot switch you to another doctor without the permission of the Industrial Commission. Insurance companies like to have you seen by doctors who they can count on to “sing their song”. Do not allow them to do this. If your employer or its insurance carrier attempts to switch you to another doctor, consult an experienced workers’ compensation lawyer immediately.

13. Failure to Consider a Second Opinion.

The law allows an injured worker to obtain a second opinion if the worker is not satisfied with the opinion of the doctor concerning the nature and extent of your disability. You should consider asking for a second opinion. However, it is not always wise to ask for a second opinion. This decision is case specific. You should consult with an experienced workers’ compensation lawyer to help you decide whether you should ask for a second opinion.

14. Assuming That the Compensation Rate Set by the Employer is Correct.

Most of the benefits you are entitled to receive from your workers’ compensation claim are based upon your average weekly wage. The average weekly wage includes the gross amount of your pay before any deductions. Average weekly wage may also be increased because of certain allowances your employer may provide such as a housing allowance. Do not be short changed by settling for an incorrect compensation rate.

15. Failure to Seek Medical Care.

It is common for an injured worker, especially a male, to try to “shake it off” after an injury not get the medical attention they should have. It is not unusual for a person to have significant injuries without realizing it. If an injured worker waits several days or weeks before seeking medical attention, the claim is suspect. This delay in treatment gives the employer still another excuse to deny the claim.

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