How your business’s workers compensation files should be documented.
Part of successful workers compensation insurance claims management is ensuring that your files are organized and well-documented. But what makes a file well-documented? Here’s what you need to know about properly documenting your workers compensation files.
What Information is Included in Well-Documented Files?
For a workers comp file to be properly documented, it needs to include several key pieces of information. For instance, your files should include the following:
- The policy number
- The policy coverage period
- The states/jurisdictions covered by the policy
- Any policy endorsements
- Any coverage exclusions
Who Should Be Named in a Workers Comp File?
Immediately after a work injury is reported, you should establish contact with relevant parties. These parties and their contact information should be documented in the claim file. Points of contact include the following:
- The injured employee
- The employer
- Any witnesses to the injury (contact information should be updated as witnesses change jobs, retire, etc.)
- The medical providers (including ambulance operators and law enforcement) that respond to the work injury
What Notes Should Be Included in the File?
The file should also include notes made by the claim handler. Relevant information such as the following should be included in the file:
- The details of the accident given by the employee in their official statement. The employer’s version of the accident. The witness statements about the accident.
- Index Bureau information and history of prior insurance claims.
- Evidence supporting or refuting the possibility of subrogation.
- The current disability status of the employee and their projected return to work date (if applicable).
- The employee’s job description, including title, duties, equipment use, etc.
- Length of time the employee has been with the company.
- The employee’s access to modified duty once they return to the workplace.
- Information on the employee’s injury, including their treatment plan, diagnosis, and prognosis.
- Subjective information such as the employee’s attitude towards the employer, returning to work, and the quality of their medical care.
- The explanation of benefits and action plan given to the employee.
- Whether or not the employee has legal representation and, if so, the representation agreement.
What Settlement Information Needs to Be on File?
If the claim is in the process of being resolved, then the file needs to include documentation that evaluates the claim and set reserves. Important information that should be on file includes the following:
- First Report of Injury
- Statements from the employee, employer, and witnesses
- Medical authorizations (necessary to obtain employee’s medical records)
- Wage records from the employer to calculate the employee’s average weekly wage
- Medical records, including past records
- Other relevant state workers compensation forms
- Police reports, EMS reports, OSHA reports, and other governmental reports on the accident
- Independent Medical Evaluations (IME) or peer review
- Vocational and rehabilitation reports
- Subrogation documentation
- Second injury fund correspondence
- Correspondence to and from the employee’s attorney and defense counsel
- Workers Compensation Board/Industrial Commission correspondence records
This is what workers compensation files need to include to be considered properly documented. Do you have other questions about your workers compensation insurance? If so, then contact the experts at PMC Insurance Group. We are ready to assist you with your coverage needs today.