Q: I have an injured employee. How do I best work with my insurance carrier to get them proper medical care and help them return to work?
The home healthcare industry unfortunately has more injured workers than most businesses due to the remote nature of the home care workplace and the fact that patients are not in good health. There are simple steps a home healthcare agency can take to help injured employees get the medical attention they need and return to work as soon as possible, and protect your agency.
Anytime someone is injured, the first thing you should do is take care of the injury. The health and well-being of your employee is paramount. Next, contact your insurance carrier and notify your insurance agent. The insurance agent and carrier are your partners. It is in their best interest to get your injured worker healthy and back to work. The carrier will be best to help you navigate the claims process. They deal with these situations frequently and can direct you to the best medical facility for navigating the workers' compensation system. Keep your insurance agent in the loop as well when you have a claim, because they are the intermediary between the agency and the insurance carrier. If the carrier is not living up to their responsibility, the agent can contact them on your behalf. There are timelines for when you must report the injury in relation to when the injury occurred. Each of these time periods is different depending upon your state. The carrier can help you make sure you have reported within the proper time period.
Once the employee is back to work, it is important to let both your agent and carrier know. The claim may stay open for a few weeks to several months after the employee has returned to work. There is a reason for this. The carrier will keep the claim open in case the employee reinjures himself or herself upon returning to work. Insurance underwriters are in the business of analyzing risk. Because they deal with risk, they tend to be conservative when forecasting the time until an injured employee is fully healthy. If a claim is open, the carrier is required to set aside a large amount of money for the possibility a claim becomes worse, requires hospitalization, surgery, or extended time away from work. If the claim is closed prematurely, it can drastically affect what you pay in premium the next year.
If you do not have a return to work program, the carrier can help you get one in place. Statistics have shown the longer a worker goes without returning to work, the more likely they are to never return. This is when the cost of an incident can get out of hand very quickly. These significant costs can negatively affect your experience modifier. If there is too much damage, it can limit your ability to find coverage and drastically increase what you pay for premium. This can also be a time when you evaluate your safety programs. If there was no formal safety program in place before the injury, this may be a good time to start one. Many agencies have taken an injured worker and turned the situation into an opportunity to improve safe working conditions.
Remember-the most important things you can do when you have an injured worker are: take care of the injury, contact their insurance carrier, and notify their insurance agent. The insurance agent and carrier are on your side and can help you through this difficult time. It is also a time to learn from the incident-examine what your business can do to improve and prevent incidents in the future.