Early Investigation of Workers’ Compensation Claims

Workers’ compensation claims often last for years and, absent a settlement agreement, employers and insurers can remain responsible for the payment of causally related medical treatment for a claimant’s lifetime.  Additionally, once attorneys are involved, there are immediate added expenses for representation and the possibility for a quick resolution fades.  The following are steps that claim adjusters can take in the early investigation of workers’ compensation claims which can help aid in a more expeditious resolution.

• First, check to see if the Employer’s First Report of Injury has been filed. This will trigger the statute of limitations and will document basic information about the incident, such as time, place, witness and body parts involved.  Note this will not generate a claim or any notice to the injured worker.
• Consider whether and when to assist the injured worker in filing a Claim Form. This is a fact-specific decision, but the Claim Form can be helpful, especially if there is no dispute as to compensability and if you need subpoena power to investigate possible matches on an Index Report or other evidence of unrelated conditions and injuries.
• Contact the employer to see if surveillance footage is available for the day and time of an injury. Such footage is more commonplace now with widely available technology, but video often is erased quickly – so act fast to preserve evidence.  If securing a video, make sure it is kept in the ordinary course of business and, if a copy is made, ensure that process is accounted for and documented to avoid any possible questions as to whether the evidence was properly gathered and maintained.
• Quickly identify any witnesses who may be able to provide a recorded statement, such as coworkers and supervisors. It is best to obtain this information while it is fresh in a witness’ memory.  If an auto accident is involved, obtain any police reports.  Accurate fact-gathering through employment records and witness statements can quickly build a basis to dispute all or part of a claim.  This will also help avoid any change in an injured worker’s description of events, as the version of events as told by witnesses or official documents will help rebut any changes to a story later.
• Investigate if an injured worker promptly reported his or her alleged incident. He or she has ten days to do so under the Maryland statute (although this rule is generally not strictly enforced).

If the goal of an employer and insurer is to resolve a claim quickly, perhaps through settlement, the above methods of investigation and prompt discussion with an injured worker can be beneficial.  Such investigation will provide necessary information to provide a basic valuation of a claim, assess the likelihood it will be found compensable, and possibly help guide early settlement negotiations.

For more information about this article, please contact John Archibald at 410.230.3064 or jarchibald@fandpnet.com.