Top 7 Ways to Handle Worker’s Compensation Claim Investigation

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workers compensation investigations new york

A thorough investigation is crucial when resolving workers compensation investigations in New York claims. Employers want their claims adjusters to deliver high-quality work. 

Regardless of the claim’s outcome, if the adjuster conducts a comprehensive investigation and offers timely feedback and information, they will be satisfied. A high degree of client satisfaction and service will lead to a high level of trust in the adjuster.

  1. Cover the Basics

This claim must be adequately and thoroughly researched in order to assess its compensability. To begin, every adjuster must have the necessary expertise and knowledge for some of the following fundamentals:

– Every state has its own set of rules; what states have the adjuster worked in?

– Were there any witnesses, and if so, were they questioned?

– What were the weather conditions like when the accident happened?

  1. Take Immediate Action

The adjuster should make contact within the first 24 hours, if not sooner, and photos should be taken. If your adjuster is unable to arrive that quickly, enlist the help of your human resources department to investigate the occurrence and take photographs. Almost everyone nowadays has a smartphone with a camera. A lot can happen by waiting just two or three days to make contact and photograph the scene.

  1. Review Video Footage

For increased security, video surveillance is becoming more widespread, and it is rapidly becoming part of the claim file. Reviewing video footage should be on the adjuster’s checklist whenever possible.

  1. Review the Medical History

Is the employee’s primary care physician or walk-in clinic appointment prior to the FROI ( first report of injury) being evaluated, and if yes, are those records being reviewed? There are best practices that the adjuster should follow when taking recorded statements.

For example, one person claimed to have twisted their ankle in the corporate parking lot on the way to work on Monday morning and filed a workers’ compensation claim. The adjuster found the employee was injured at a soccer game over the weekend while checking numerous medical data from the physician and hospital, and the claim was later denied.

  1. Pay Attention to Details

The weather conditions on the day of the accident and at the time of the accident are critical. What method does the adjuster use to verify the weather conditions?

Simple Google searches will yield a wealth of data. There is a slew of other websites that can supply you with even more weather information. Sites also include events such as fog and thunderstorms for each day down to the hour, in addition to temperature, humidity, visibility, and wind for a given day. 

  1. Stay in Contact with the Worker’s Compensation Carrier

On the employee’s claim, organizations must keep in touch with the workers’ compensation carrier. Medical documentation may be required by the employer to be sent to the workers’ compensation carrier. Furthermore, the workers’ compensation carrier may require the employer to complete papers. In order to establish pay replacement benefits, these documents may seek information such as the number of lost workdays, the employee’s return-to-work status, and any salary continuation.

  1. Stay in Contact with the Employee

The agent then informs the employee that the claim has been submitted and when the workers’ compensation carrier will contact them about wage replacement and medical treatment. Next, the representative should set up a regular phone, mail, or e-mail follow-up on the employee’s progress to let the employee know that his or her well-being and return to work is vital to the company.

Wrapping Up:

Workers compensation investigations New York claims that have been handled properly are not a problem for insurers. Insurers expect their adjusters to provide high-quality claim handling, regardless of whether the claim is allowed or refused. To make the best decisions during the claim handling process, it’s critical to consider all of the factors surrounding the event.