Seven Steps to Reduce Workers' Compensation Costs

1. Sound hiring practices 

Thorough pre-employment background checks reduce WC costs. Ask applicants to explain any concerns identified during a background investigation. If you do business in multiple states, a professional applicant-screening agency can help ensure pre-employment background investigations abide by all local, state, and federal laws and regulations. Consider pre-employment drug testing, as drug users can be unsafe workers and more likely to file false claims.

2. Pave the way for return-to-work

Returning employees to work as soon as possible after an injury will also reduce claim costs while improving productivity and employee morale. Early assistance allows an injured worker to maintain a connection to the workplace and lessen frustration and worry. Your return-to-work plan could include job descriptions describing temporary or alternate duties to be performed in certain circumstances. Let employees know that your goal is to help them get well and return to work in the event of injury.

3. In-House Surveillance 

In-house surveillance monitoring will provide insights into legitimate claims and speed benefit administration. It can also provide evidence into potential fraud and support additional investigation. Both covert and overt surveillance monitoring may be appropriate, depending upon the job site, the type of claims filed, and privacy concerns. If an injury is alleged, the video and log should be quickly secured for evidence and chain of custody. If the video does not match the employee’s description of the injury, share the video with medical providers to ensure only warranted benefits are obtained. Sharing information with your Special Investigation Unit partner will ensure both claim benefits and potential fraud are considered.

4. Investigate Reported Injuries 

Supervisors and managers should be trained to respond immediately to any reported or rumored injury. Promptly recommend your predetermined medical provider to the injured employee. A professional investigation should be conducted as soon as possible. A detailed description of the accident and injury should be obtained, and any relevant workplace evidence preserved. A timely investigation will also help ensure the timely administration of appropriate benefits. Thorough investigations will secure workplace equipment such as machines or other evidence and include a scene inspection, photographs, and statements by the injured worker and witnesses. An investigation may also gather public records, criminal and civil court records, department of motor vehicle records, and include a search for prior claims. Other relevant records such as a police report, 9-1-1 call record, OSHA report or others may be appropriate. The investigation can identify potential subrogation, enabling the claim professional and defense attorney to pursue potential third-party liability. It will also highlight red flags or suspicions. Having a professional, third-party investigative agency conduct the initial compensability investigation is a critical tool in preventing fraud.

5. Implement a safety program 

A safe workplace discourages fake or exaggerated injuries. Hold regular safety meetings and remind employees about workplace safety through use of social media, posters, flyers, and newsletters. Some employers reward workers for meeting safety milestones. Use onsite ergonomics solutions to help employees perform tasks the correct way and reduce repetitive injury claims. Encourage employees to identify potential safety issues, share their ideas for improving workplace safety, and report injuries promptly.

6. Open Door Policy

An open-door policy will encourage employees to share information and report suspicions. Employees may have insights about an incident or injury and may provide valuable information:

• Was the employee complaining before the alleged injury about work, physical pain, or personal problems?
• Was the employee disgruntled or denied a salary increase or promotion?
• Has there been a change in job duties, reporting supervisor or responsibilities?
• Did the injured worker mention family problems such as health issues, additional family responsibilities or other personal situations?

Listen carefully after a workplace injury and during the claims process. Information may filter through the workplace and keeping an ear to the ground may help weigh a claim’s validity.

7. Create a Specialized Team

Managing workers’ compensation claims demands a strong, pro-active, and dedicated team. Your team should include experienced claim management professionals, specialized legal support, risk managers, and a licensed investigative agency specialized in workers’ compensation. Your investigative agency may be provided by your insurance carrier or contracted directly. Either way, your investigative partner must have a Special Investigation Unit (SIU) of certified fraud specialists. Communicate frequently with your claim professionals to ensure that they are actively identifying red flags and thoroughly investigating claims. If you are self-insured or in a high-deductible program, it is important to partner with an investigative agency that has an SIU team with a successful track record. Diligence is the best way to stop unwarranted benefits and fight fraud.

Uncover the Facts. Put VRC Investigative Experts to Work for You Today.

We welcome any questions regarding investigations or our fraud abatement partnerships at experts@vrcinvestigations.com or daleneb@vrcinvestigations.com