Reporting claims in a timely manner not only is cost-effective, but creating an encouraging reporting culture can also promote a successful claims management program.
It is illegal to conceal or fail to submit a workers’ compensation claim.
Workplace accidents happen due to unsafe conditions, inadequate training and ignoring near-misses. Although accidents can’t be eliminated entirely, injury prevention is an essential component of efficiency and profitability. The goal is to reduce both the frequency and severity of claims. A culture in which employees are encouraged to speak out about safety concerns without fear of reprisal is imperative in averting claims. When a claim does occur, a culture invested in identifying and addressing the root cause will benefit the company. The key to a successful culture change in workers’ compensation reporting is a shift in thinking and behavior that is consistently reinforced by management until expectations are realized.
In a January 2009 article in Proofs Magazine, William Penney says that 69 percent of injuries may never make it into the BLS Survey of Occupational Injuries and Illnesses. The most probable driving force in underreporting workers’ compensation claims is that employers pay the total cost of medical care versus health insurance which involves co-pays. Other factors include a lack of understanding of reporting requirements, economic and/or peer pressure, safety/bonus incentives, an attempt to maintain or gain government contracts or an avoidance of OSHA inspections. When an employee submits a claim under their personal health insurance, the claim does not affect a company’s experience modification factor or workers’ compensation premium.
It is illegal to conceal or fail to submit a workers’ compensation claim. Although it may appear that underreporting workers’ compensation claims is cost effective, studies have shown that this practice often increases costs. Unreported and untreated soft tissue injuries, especially back injuries, may become more severe over time and eventually require more medical care and possibly surgery. The National Council on Compensation Insurance (NCCI) reports that injuries reported within two weeks are 18% more costly than those reported within the first week and injuries reported in the fourth and fifth weeks are 45% more costly. Additionally, claims that are reported late are more likely to be litigated. The NCCI finds that injuries reported within 10 days are 22% more likely to be litigated whereas claims reported 31 days after the loss are 47% more likely to be litigated.