How we Manage the Human Side of Risk
Frequently asked questions
Issues covered during the investigation, when properly utilized, can assist with the discussion to accept or deny a claim for benefits, setting the case based reserve, and in the negotiation of a compromise settlement.
A proper investigation should cover issues like:
- Course and Scope (Statutory employer and borrowing employer issues)
- Cause of the incident (Subrogation Issues)
- Arising out of (witness identified)
- Injuries (Compensability issues)
- Prior medical history (Second Injury Fund Issues)
- Prior education (Return to work issues)
- Work history (Return to work issues)
- Family structure (Secondary gain issues)
- Average weekly wage (a prime target for penalty and attorney fee claims)
- Catastrophic Injuries*
- Cases involving back, shoulder, and knee injuries*
- Owner-operator claims*
- Drug defense cases*
- Aggressor claims that can turn into intentional tort lawsuits
- Subrogation claims
- Identification of second injury fund claims potential
- Statutory, borrowing and/or joint employer situation*
- Uninsured sub-contractor claims
- Potential 1208 and 1208.1 cases
- Cases involving coverage disputes
- Medical set aside issues
*High potential for Second Injury Fund Recovery
The Louisiana Second Injury Fund is a state agency which reimburses employers and Louisiana Workers Compensation companies for part of the income and medical benefits they pay in cases where an employee who had a pre-existing disability experiences a new on-the-job injury that is covered by Louisiana Workers Compensation. Every Louisiana Workers Compensation insurance company, and every self-insured employer, who has paid Louisiana Workers Compensation benefits in the preceding year must make contributions to the Louisiana Second Injury Fund.
In workers’ compensation, the Experience Modification Rating (EMR) is a critical component of your premium calculation. It is a method for tailoring the cost of insurance to the characteristics of an employer. An employer’s EMR is calculated by comparing its claims history to those of similar companies in its industry. Higher than normal rate of injuries in the past, can result in a premium surcharge. You can manage this risk by investing in a safety program to help avoid accidents and by taking proactive steps to ensure proper handling of accidents when they do occur. Let’s face it, accidents happen. When an accident is handled properly from the start, it can mitigate the impact to your EMR.
By involving a workers’ compensation “Coach” from the onset, you will ensure that your employee’s injury claim is handled correctly from the initial injury report to the initial doctor’s visit. Our goal as your “Coach” is to provide the immediate, professional help you need when an employee reports an injury. Our workers’ compensation specialists are standing by to “Coach” you and your staff through the injury handling process. This is a low cost consulting program designed to help you protect your experience modifier.
To learn more
Contact our RiskSAVERS