Workers Compensation

Back Injuries: Understanding and Prevention

The most frequent type of injury in the U.S. is back strain. Over 80% of adults will suffer back pain during their lives. According to a Duke University study, back injuries cost nearly $90 billion annually. With this in mind, it may surprise you that back injuries and associated pain can often be controlled with simple solutions like correct posture and basic exercises. Even people who have injured their back in the past can adopt certain strengthening exercises to avoid recurring injuries.

Structure of the Back To prevent back injuries one must understand how the back and spine are structured. The back is composed of a carefully balanced mechanism of bones, muscles, ligaments, tendons and nerves that balance and bear the weight of your body, plus the loads you lift and carry. The spinal column consists of 24 vertebrae and 23 discs that act as cushions and shock absorbers. The spinal column protects the sensitive spinal cord and is sheathed by ligament and muscle tissue. The spine has three natural curves: the cervical (neck), thoracic (upper back) and lumbar (lower back). Each spinal segment has a nerve network emerging from the spinal cord through a channel in the vertebrae that monitors or controls a particular function of the body. When this system gets out of balance, or wears out, back pain occurs.

Causes of Back Pain: Back pain and discomfort have many sources. Some of the more common causes are:

  •  Excess weight and poor muscle tone
  •  Herniated or .slipped. discs
  •  Muscle strains and spasms
  •  Osteoarthritis . slow cartilage deterioration due to excessive use, injury or aging
  •  Osteoporosis . a calcium deficiency in the bones
  •  Sciatica . pressure on a nerve root in the lower back
  •  Stress

Home Care Measures for Minor Back Pain: 

  • Apply cold, then heat – use cold treatment first, then a warm treatment for about 20 minutes 
  • Over-the-counter medications . such as pain relievers and anti-inflammatory drugs 
  • Get plenty of rest and do not exert yourself. – practice correct posture.
  • To rest the back, recline, do not sit, which will usually aggravate the problem! In most cases, minor back pain eventually heals itself with time and proper care.

For Chronic Pain, See a Physician: Persistent back pain can signal serious medical problems. A physician should be seen if back pain is the result of a fall or traumatic accident. Other signs of serious back injury include numbness in the legs or other unusual health problems. A doctor may recommend treatment with a specialist and prescribe treatment including: back education seminars, massage and heat/cold applications, prescription medications, physical therapy and exercise, or back surgery as a last resort. Be sure to get a second medical opinion if considering surgery.

Preventing Back Pain: Regular exercise is probably the best way to reduce the likelihood of back pain. Such activity can increase aerobic capacity, improve overall fitness and help control weight. Stretching and toning of the back and stomach muscles can help reduce the wear and tear on the spine. Strength training can make arms, legs and lower body stronger. Walking should be emphasized, as most doctors consider it the most acceptable form of both preventive and therapeutic exercise for the back. Always consult a physician before starting an exercise program.

Prevent Injury Both on and Off the Job:

Back care training should emphasize the need to develop good habits 24-hours a day and should include the following;

  •  Avoiding falls
  •  Wearing proper footwear
  •  Maintaining the natural curve of the back
  •  Proper lifting techniques
  •  Taking breaks and resting if back pain occurs
  •  Taking time to be careful

What Supervisors can do to Prevent Employee Back Injury:

Discuss back care during employee orientation, conduct effective on-going safety training, match the right employee to the job, observe and correct improper lifting habits, use material handling aids whenever possible, study and correct any ergonomic problems, and promote wellness.

 

OHSA’s Hazard Communication Standard

The following information can be found from FirstComp Insurance.  To see a full copy, click here.

Paint remover, degreaser, fertilizer and glass cleaner; these and other chemicals are a part of today’s high quality of life and a necessary part of many work environments. The hazard communication standard first went into effect in 1985 and covers almost all workplaces under OSHA jurisdiction. The basic idea behind the standard requires chemical manufacturers and employers to communicate information to workers about the hazards of workplace chemicals or products. Material Safety Data Sheets (MSDS), container / product labels,  employee training and a written program are the main components for communicating chemical information to employees. These elements are designed to prevent injuries and keep workers healthy and safe while performing their job.

Health and Safety

The best way to protect employee health and safety is to educate them on each of the chemicals they work with. Some chemicals can explode, start fires or violently react with others. Some can cause skin rashes, breathing problems, or more serious injuries including burns and death. But if hazardous chemicals are handled carefully and the proper precautions are followed, chemicals can be handled and used safely.

MSDS and Labels

Illness and injury can be prevented by reading the MSDS and container / product label for each chemical being used. These two major program components provide important health and safety information about the hazardous chemicals employees will be working with. Employers must make MSDS.s and labels available to workers, but the program can only be effective with the help and cooperation of all employees.

Be Compliant

Many employers think the Standard doesn’t apply to their workplace.  However, the vast majority of workplaces under OSHA jurisdiction have some exposure to chemicals that require documentation and proper labeling. Some examples of common chemicals are household or commercial cleaning fluids, fuels, solvents, lubricants, degreasers, and aerosols.

Take Part

Work smart by participating in the company’s hazard communication program. Safe work practices for properly handling chemicals, how to use required personal protective equipment, and any first aid procedures in case of an accident will be taught. Since health and safety is your responsibility, be sure to understand the job function, and ask your supervisor any questions regarding using and/or handling chemicals safely.

Claimant Fraud

Special Investigation Unit Manager Accidents may occur. However, when employees are involved in fraudulent claims it hurts entire communities, especially an employer, whose workers compensation insurance premiums increase due to the loss. At FirstComp we are dedicated to protecting policyholders by combating fraud. Below is a story of a win in the battle against workers compensation fraud:

Sam was a convenience store clerk who felt he should only work when he wanted to. Before starting his shift on a Friday evening he devised a plan to skip work and still be paid. Early in his shift he paced up and down a store aisle watching customers and his co-worker at the register. Once he realized his coworker was distracted he walked over to a wire rack – and shook it – to see if it would fall. Realizing no one was watching he pulled the wire rack down on himself and started screaming for help. Eventually, an ambulance was called to transport him to the hospital. What Sam did not realize was the store not only had a video camera over the cash register but also over the store aisles. His .staged. accident was caught on video tape.

Sam faces up to 5 years in prison for workers compensation fraud if convicted by a court of law. Some potential fraud red flags to be on the lookout for include:

  •  The employee has injuries that do not match with the story of the accident
  •  There are no witnesses to the accident
  •  The accident occurred early on a Monday morning or after a holiday weekend
  •  The accident leads to rumors or whispers around the workplace that the injury was faked

 

Safety Meetings

The following information comes from FirstComp Insurance.  The full article can be found here.

Mention safety meetings, and you’ll likely get one of two responses; fear if you’re leading the meeting, or apathy and disdain if you have to attend. If safety meetings are so painful, why do we have them? To find the answer to this you must ask yourself, are you holding safety meetings because you have to or because it’s a health and safety program requirement?

It’s true the Occupational Safety and Health Administration has a standard that requires employers to instruct employees to recognize and avoid unsafe conditions in their work environment. That being said, you should be holding safety meetings because you want to ensure that everyone is on the same page when it comes to the safe and efficient running of your organization. Basically, you want to share and receive information. You want to know if there are problems in the workplace as well as what is working well. In short, you want regular two-way communication between management and staff. Furthermore, research shows that effective, open, regular communication about safety and health issues is a critical component in preventing injuries and illnesses in the workplace.

To conduct an effective safety meeting it is important to follow established guidelines and procedures. s also important to establish and follow a meeting agenda. A safety meeting should cover the benefits associated with complying with safety policies and procedures as well as consequences or penalties for non-compliance.

The following guidelines can help destroy fear and apathy, and make every safety meeting effective:

  • Safety meetings should be held at regular intervals during the year. Since safety is a state of mind regular reminders can make workers more conscious of hazards.
  • Meetings should be held at a time which is convenient for all attendees.
  • To get maximum cooperation try a single topic approach that involves as many people as possible, and confine your talk, suggestions and questions to that single topic. Avoid  loading your meeting with generalities, i.e., “be careful with tools” or “watch your housekeeping”. Once you deliver your points, make sure everyone understands any new rules or procedures.
  • Ideally, each lesson should be conducted in an area that is most applicable to the topic at hand. Select a location near the topic being discussed where people can be comfortable and are free of distractions.
  • If you are talking about portable equipment such as ladders or hand-tools, have them with you as props so you may refer to them during the discussion. Don’t let anything, i.e., phone calls interrupt the meeting.
  • Inform attendees in the beginning that you are limiting the meeting to a certain time frame, i.e. 30 minutes. If discussions get lengthy continue it at the next meeting otherwise it will become boring which could turn everyone off. Read the lesson or present it in your own words; or you may state the subject of the discussion and ask questions to develop the discussion.
  • After your presentation, encourage feedback among attendees.
  • Review recent on-the-job accidents or injuries including near misses. Then solicit suggestions about how they could have been prevented or the violation corrected. Do not criticize anyone or anything in front of the group.
  • Keep a record of the meeting and review open items at the next meeting. Prioritize any items that need to be corrected, and create a timetable for corrective

OHSA Record Keeping

The following information comes from FirstComp Insurance.  You can read the full copy here.

Every employer covered by the Department of Labor’s Occupational Safety and Health Administration (OSHA) with more than ten (10) employees (except employers in certain low-hazard industries – retail, finance, insurance, real estate, and service sectors) must maintain specific records of job related injuries and illnesses. Despite the exceptions, all employers must report by telephone or in person to the nearest OSHA office within eight (8) hours of any work-related fatality or inpatient hospitalization of three or more employees. OSHA approved State Plans may have stricter requirements regarding: reporting of fatalities, catastrophes or multiple injuries, industry and size exemptions, and record access provisions. For specific requirements please contact your local state OSHA office.

Recording Criteria:

Generally an injury or illness must be considered work-related if an event or exposure either caused or contributed to the resulting condition or significantly aggravated a pre-existing  ondition. An injury or  illness is considered to meet general recording criteria if it results in any of the following: death; days away from work, restricted work or transfer to another job (DART); medical treatment beyond first-aid; loss of consciousness; or involves a significant injury or illness diagnosed by a physician or other licensed health care professional. The following must also be recorded: work related needlestick injuries and cuts from sharp objects that are contaminated with another person’s blood or other potentially infectious material are recordable; an employee that is medically removed from work under the requirements of a specific OSHA health standard; an employee’s hearing test (audiogram) reveals that an employee has experienced a work related Standard Threshold Shift (STS) in hearing in one or both ears, and the employee’s total hearing level is 25 decibels (dB) or more above audiometric zero in the same ear as the STS; an employee is exposed to someone with a known case of active tuberculosis (TB), and subsequently develops a TB infection.

Recordkeeping Forms:

OSHA provides three basic forms OSHA Forms 300, 300A and 301 for recordkeeping purposes. Form 300 is called the “Log of Work-Related Injuries and Illnesses” and is used to record specific information applicable to each recordable case. Form 300A is the “Summary of Work-Related Injuries and Illnesses” and is used to summarize Form 300 information at the end of the year. OSHA Form 301 is the “Injury and Illness Incident Report” and includes additional data on how the injury or illness occurred. An equivalent form such as your company’s incident report form can replace OSHA Form 301, as long as the equivalent from includes all of the same data. Within seven (7) calendar days of receiving information about a case, the employer must decide if the case is recordable, and then complete the 300 “Log” and the 301 “Incident Report”.

Other Requirements/Considerations:

● Employers must set up a specific method for employees to report injuries and illnesses, and must instruct all employees on how to report. An employer may not discriminate against an employee for reporting a work-related injury or illness.

● Cases such as; use of nonprescription medications, tetanus shots, cleaning, flushing or soaking of wounds, use of bandages, wraps or eye patches, use of hot, cold or massage therapy, and drinking fluids to relieve heat stress are considered first-aid and are not recorded.

● Employers must record the injuries and illnesses of all employees on payroll including temporary workers since the company exercises day-to-day control over them.

● Employers are allowed to cap the number of days away and/or restricted work/job transfer when a case involves 180 calendar days.

● If a company has more than one establishment (a single physical location where business is conducted or where services or industrial operations are performed), then a separate Form 300 must be maintained for each establishment expected to be in operation for more than a year. Industries such as construction and transportation are examples where employees do not work at a single location. For these, the establishment is a main or branch office that either supervises such activities or serves as the base location.

● For privacy cases, employees may request that their names be withheld from the 300 form. Reasons may include; injuries to the reproductive system, sexual assault, mental illness, HIV, hepatitis, sharps with contamination, tuberculosis, or voluntary request by the employee.

● Employees, former employees, their personal representatives, and their authorized employee representatives have the right to access the 300 Log Form and the 300A Summary Form. If requested, the employer must provide the requester a copy of the forms by the end of the next business day.

● Since records are generally not filed with OSHA, they must be maintained at the worksite for five (5) years and made available to employees and OSHA inspectors upon request. In addition, they must be updated to reflect changes that occur in recorded cases, and new entries must be made for previously unrecorded cases.

● Form 300A must be finalized at the end of each calendar year. A company executive must certify and sign the form. Additionally, the form must be displayed (where notices are normally posted) for a 3-month period beginning on February 1st and ending on April 30th of the year following the year covered by the summary. This also applies if there are no recordable cases for the year.

Office Safety

The following information comes from FirstComp Insurance.  You can read the full version by clicking here.

We generally think of the “office” as a safer place than manufacturing or construction environments. The risk of an occupational injury for office workers is lower than that of employees involved in other industries. However, injuries can be just as painful, severe and expensive. One reason office safety and health programs are not more widespread are that many organizations believe office injuries are minor. As a result, office hazards go unrecognized and unmanaged, and do lead to serious injuries and property loss. An organization’s safety program cannot be fully effective if there is only partial participation by employees and management. A safety program that is not pursued in company offices probably will not be vigorously pursued in other areas of the organization.

Types of Disabling Injuries

In a recent study, falls were found to be the most common office incident and account for most disabling injuries. Falls from chairs occur when a person is sitting down, getting up,  eaning back or moving about in a chair. Falls on the same level includes: slipping on wet or slippery floors and tripping over equipment, cords, damaged flooring or litter. Falls from elevations also occur when standing on chairs or other office furniture, and from ladders, loading docks, or other elevations.

Overexertion

Strain or overexertion occurs while employees try to move objects such as carrying or moving office machines, supplies, file drawers, trays, office furniture, heavy books or other loads. Reaching, stretching, twisting, bending down and cumulative trauma are often associated with these injuries.

Objects Striking or Struck by Employees

These injuries occur when  employees are struck by falling objects such as; overbalanced file cabinets, file drawers pulled out too far, supplies and equipment sliding from shelves or cabinet tops, office machines and other objects dropped on feet while being moved, equipment that falls from a desk or rolling stand, and employees struck by doors being opened. Striking against injuries occur when employees bump into doors, desks, file cabinets, open drawers, baskets and other people while walking.

Caught in or Between

Injuries also happen when employees get caught in or between machinery and equipment such as; drawers, doors, windows, copying machines, shredders, etc. Knife edges on paper cutters can cause serious finger lacerations/cuts.

Miscellaneous

Other common types of office injuries include; foreign substances in the eyes, burns from spilled hot liquids, insect bites, electric shocks, chemical exposure from cleaning supplies, repetitive motion, and paper cuts. The good news is that most office hazards can easily be controlled by; being aware, working safely, and by eliminating or minimizing recognized hazards. Follow these tips to reduce potential injuries and accidents in your office:

  •  Ensure cords and/or communication cables are not stretched across aisles, doorways or between desks.
  •  Store heavy and most frequently used supplies/materials between the chest and knees to reduce strain type injuries.
  •  Use a material handling device (i.e. hand truck, dolly, cart, etc.) to move heavy or awkward items.
  •  Ensure work and storage areas are properly illuminated without shadows or glare.
  •  Adjust computer workstations so arms, wrists, legs, back and neck are always in a comfortable, neutral position. Avoid awkward postures or positions such as reaching, twisting, bending, slouching, etc.
  •  Interrupt repetitive tasks with regular rest breaks and include light stretching to promote movement and blood circulation.
  •  Minimize office noise by redirecting phone conversations, lowering music volume, isolating noisy office equipment, and keeping HVAC and other equipment properly serviced.
  •  Keep areas underneath desks clear as this can restrict movement .
  •  Avoid spills and wet areas on slippery, uncarpeted floors. Mark the hazardous area with a “wet floor” sign until the floor dries.
  •  Prevent file cabinets from tipping by; bolting, opening only one drawer at a time, and not overloading drawers. Close drawers and doors with the flat of your hand.
  •  Ensure that all appliances and other electrical devices are properly protected, frayed cords can lead to serious electrical shock and fires. Don’t overload outlets or use extension cords as permanent wiring.
  •  Never use office chairs or other furniture as step stools.
  •  When using stairs: always use handrails, remove trash or debris, never carry items while ascending or descending, and never use stairs for storage.
  •  If there are blind corners consider installing convex mirrors to improve visibility. Don’t stack or pile “stuff” on top of filing cabinets which can block lines of sight.
  •  Know your building emergency procedures, evacuation routes, and assembly areas. Know the location, and how and when to use a fire extinguisher. Keep exits and aisle ways clear to allow for quick evacuation.
  •  Properly dispose of matches,ashes and cigarette butts. Maintain good housekeeping practices at all times.
  •  Conduct periodic facility inspections to make your office safe. Look around, and you will spot other hazards that can be easily fixed. When you see a hazard, don’t assume it is someone else’s responsibility to correct.

 

Forklift Safety

The following information comes from a FirstComp Insurance newsletter.  To see a full copy, click here.

Powered industrial trucks (PIT’s) commonly known as forklifts, pallet trucks, rider trucks, fork trucks or lift trucks are found and used in many industries and workplace operations. Powered by electric or internal combustion engines, there are seven different classifications of these very specialized vehicles commonly used to carry, push, pull, lift or stack materials of various sizes, shapes and weights. According to the Occupational Safety and Health Administration (OSHA), there are about 1 million forklifts used by 1.5 million workers. Approximately 95,000 people are injured, and 100 are killed annually while operating these useful but sometimes hazardous vehicles. According to OSHA, most of the injuries, accidents and property damage can be attributed to three main causes:

  •  Failure to follow safe operating procedures,
  •  Lack of safety rule enforcement, and
  •  Insufficient or inadequate training.

On a positive note, these accident causations can be controlled and corrected with foresight and effective supervision.

Training & Evaluation

According to OSHA standard Code 29 CFR 1910.178, “Only trained and authorized operators shall be permitted to operate a powered industrial truck.” As a result, OSHA requires that each PIT operator to be over 18 years of age and be competent to operate these vehicles safely as demonstrated by the successful completion of training and evaluation. Training programs can be administered by the employer or through a third party acting on behalf of the employer. Training must be conducted by a person with the knowledge, training and experience to train PIT operators and evaluate their competence. Effective training must consist of a combination of: Formal instruction (e.g., lecture, discussion, interactive computer learning, video, written material), Practical training (trainer demonstrations and practical trainee exercises), and Evaluation of the operator’s performance in

the workplace.

Training program content must consist of:

  • PIT related topics (e.g., operating instructions, warnings and precautions, controls and instrumentation, motor/engine operation, steering and maneuvering, visibility, vehicle attachments, vehicle capacity and stability, inspection and maintenance, refueling/ charging, etc.)
  • Workplace-related topics (e.g., driving surface conditions, stability of the load, load stacking and unstacking, pedestrian traffic, aisles and restricted areas, operating in hazardous
  • locations, operation on ramps and sloped surfaces, potentially hazardous environmental conditions, operating in closed or poorly ventilated areas, etc.)
  • Requirements of the applicable OSHA standard

Although there is no mandatory annual refresher training requirement, employers are required to certify that each PIT operator has

received initial training and must re-evaluate each operator at least once every three (3) years. Furthermore, refresher training in relevant topics is needed whenever:

  •  An operator demonstrates a deficiency in the safe operation of the vehicle,
  •  Workplace conditions change in a way that could affect safe operation,
  •  An operator is involved in an accident or near-miss,
  •  An evaluation indicates need,
  •  An operator is assigned to a different kind of PIT

Employer certification and evaluation of each operator must include the name of the operator, the date of training, the date of evaluation and the identity of person(s) performing the training or evaluation.

Documentation must also be maintained in the operator’s personnel file. Failure to certify any employee operating a PIT can result in costly OSHA fines and other penalties.

Operator Qualifications

Federal OSHA’s Powered Industrial Truck standard has no requirement that the operator possess a valid, state issued driver’s license. The employer must however, have a record documenting that the driver has successfully completed PIT training. This would be the only operating “license” required by OSHA.  Also, even though there is no vision/hearing test requirement addressed in the standard, OSHA could still cite under the General Duty Clause (Section 5(a)(1) if an employer was aware of a physical impairment and still allowed an employee to operate a PIT.

Glaziers – Investigating Employee Accidents

The following information comes from a FirstComp Insurance newsletter providing tips and tricks for investigating accidents.  A full copy can be found here.

Thousands of accidents occur throughout the U.S. every day. Most of these are caused by the failure of people, equipment, supplies, or surroundings to behave or react as expected. Accident investigations determine how and why these failures occur. By using the information gained through an investigation, a similar, or perhaps more disastrous, accident may be prevented.

Accident investigations are an important component of health and safety programs, and an essential part of building a successful workplace safety culture.

Reasons to perform accident investigations often include:

  •  Fulfillment of legal requirements
  •  Assessing compliance with established safety procedures
  •  Prevention of future accidents
  •  Enabling the processing of worker’s compensation claims
  •  Demonstrating concern about employee well being

An accident can be described as an unintended event that results in injury or property damage. An incident can be described as an unintended event that does not result in injury or property damage. Additionally, hazard can be described as the potential to do harm, while risk is defined as the likelihood of harm actually occurring.

Other terms such as “Near miss” are used to describe incidents that could have easily ended up being serious accidents. Some jurisdictions avoid the use of the term accident”, because the term infers that the event could not have been avoided. They choose to use “incident” instead, pointing out that most events are predictable and preventable. To the extent that the risk is managed, there is less chance of an accident occurring. The depth of the investigation should be appropriate to the seriousness of the situation in terms of actual or potential injury.

Looking to Determine Root Cause

In the past, accident investigations have typically focused on assigning blame rather than finding the underlying root cause, which if addressed, can reduce the likelihood of a similar accident.

Choosing an Investigation Team

The investigation should be conducted by someone who is familiar with the workplace and has been trained in the accident investigation process. Typically, the immediate supervisor is involved, although the level of management participation will be influenced by the seriousness of the accident. The more serious the accident, the more likely that senior managers will participate. Worker participation also aids in effective investigation. Such workers should be familiar with the work being done. These often include, but are not limited to the health and safety representative, union representative or others. In addition, outside experts may be called upon to participate. Investigations are strengthened by the perspectives of others who are knowledgeable about the workplace and investigation procedures.

The Accident Investigation Process

The accident investigation process includes six

important steps. These include:

  •  Investigation of the accident
  •  Identification of direct & root causes
  •  Disclosure of findings
  •  Development of a corrective action plan
  •  Implementation
  •  Follow-up review and revision as necessary

Timely Investigation

In order to perform a proper initial investigation, it should take place as soon as possible after the accident scene has been deemed safe. Tools useful to the investigator will include such items as a camera, tape measure, flashlight, investigation form, pencil, etc. The initial investigation will involve aiding the injured worker, recording physical evidence, and then interviewing workers separately. The Six W’s is one simple but proven methodology that helps field investigators build a solid understanding of the event: Who is it about? What happened? Where did it take place? When did it take place? Why did it happen? How did it happen?

Discovering Immediate and Root Causes

The workplace factors are assessed to see if they have been contributing factors. Such factors include: People, Material, Environmental, Management System and Work/Process Task factors. In determining the cause of an accident, it is often easier to identify the immediate cause rather than the root cause. With this in mind, one commonly used approach is to employ the Three Why’s technique. For example, the immediate cause of an employee slipping may be due to a wet floor. “Why did the employee get hurt?” The next why may be “Why was the floor wet?”

When finding out that the organic recycling bin is leaking fluid, the next question may be: “Why is the bin leaking?” Through such process the recommendation of the committee may be to repair or replace bins so that they do not leak. Additionally, investigators may recommend temporary measures to reduce risk until the bins are replaced – perhaps relocating the bins. Another recommendation might be for a scheduled inspection of bins to make sure that they are not leaking.

While this has been a fairly simple illustration, techniques such as the Six W’s and the Three Why’s can be used to investigate many accidents in conjunction with the basic investigative steps.

How to Reduce Workers Compensation Fraud

1. Educate your employees about workers compensation fraud and its consequences.  Re-enforce that workers are the real victims of fraud.  If your premiums are high, you can’t afford raises, bonuses and other incentives.

2. After an accident, refer the employee to your designated physician. Avoid “doctor shopping” by using a preferred provider who understands workers compensation injuries.

3. Interview the injured employee for details of the accident.

4. Interview witnesses and obtain written statements.  Pay attention to what other employees are saying to each other about the accident.

5. Investigate the scene for facts that corroborate or contradict the employee’s account of the accident.

6. Enforce drug testing. It is important to have a policy in place that requires screening after an accident.

7. Watch for the red flags of possible fraud. Stay in close contact with your injured employee. Contact makes an employee feel valuable and promotes an early return to work.

8. Implement modified duty when possible. Bringing an employee back to work can reduce costs and increase communication.

9. Fill out the Employer’s First Report of Injury Form in detail, even if it requires an extra page.

10.  Report any concerns to your adjuster as soon as possible. With early intervention, you can document information that may be lost, forgotten, or concealed later.

Red Flags of Workers Compensation Fraud

Employee Red Flags

– Is seldom available at home

– Delays return to work after maximum medical improvement

– Refuses light duty opportunities

– Is vague or contradictory about how the injury occurred

– Was in jeopardy of termination or probation prior to injury

– “Shops” for a provider and/or is noncompliant with treatment

– Conceals pre-existing medical information relevant to the claim

– Delays reporting the injury

– There is evidence that the employee has other concealed employment and/or is participating in activity that is contradictory to reported physical limitations

– There is no witness to the injury nor resulting symptoms

Employer Red Flags

– Fabricates location or type of operation

– Under reports payroll

– Medical Provider Red Flags

– Bills for services not actually rendered

– Bills for products not actually provided

– Over bills

– Fabricates procedures

– Unbundles services

Identifying Workers Compensation Fraud

Here are the top 10 warnings signs a workers compensation claim is potentially fraudulent:

Monday Morning Reports

The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday.

Employment Change

The reported accident occurred immediately before or after a strike, job termination, layoff, end of a big project, or at the conclusion of seasonal work.

Suspicious Providers

An employee’s medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants.

No Witnesses

There are no witnesses to the accident and employee’s own description does not logically support the cause of the injury.

Conflicting Descriptions

The employee’s description of the accident conflicts with the medical history or First Report of Injury.

History of Claims

The claimant has a history of a number of suspicious or litigated claims.

Treatment is Refused

The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.

Late Reporting

The employee delays reporting the claim without a reasonable explanation.

Claimant is hard to reach

The allegedly disabled claimant is hard to reach at home.

Changes

The claimant has a history of frequently changing physicians, changing addresses and numerous past employment changes.

Experience shows that when two or more of these factors are present in a workers’ compensation claim, there is a chance the claim may be fraudulent.  Remember though, that these are simply indicators. Many perfectly legitimate claims are filed on Mondays-and some accidents have no witnesses.