WCRI: AVOIDING LITIGATION OVER COMPPosted On: Mar. 16, 1997 12:00 AM CST
CAMBRIDGE, Mass.-Some employers, insurers and state agencies unknowingly follow "a recipe for litigation" with their workers compensation claims-handling practices.
The ingredients are: "pay late, do nothing, deny often, make unrealistic offers, negotiate permanent partial disability with no framework and don't talk."
Those practices to avoid were identified by researchers at the Cambridge, Mass.-based Workers Compensation Research Institute who studied about two dozen state systems. Carol A. Telles, the WCRI's manager of administrative studies, summarized them earlier this month at a WCRI conference.
Jane Eden, a claimants attorney with Eden, Tolines & Rafferty in Worcester, Mass., also echoed practices to avoid. "You never want to forget that many of the people out there have been legitimately injured and deserve the protection of the system," she said.
Yet some employers do forget.
At least one worker came to her because an employer made the worker finish the shift before seeking medical treatment. Another worker had difficulty getting the name of an employer's workers comp insurer, perhaps because the employer did not plan to report the injury, Ms. Eden said.
Employers have a right to monitor an injured worker's condition and encourage return to work, but that can be excessive when a worker with a fractured hip is told to come to work and lie on the floor, she said.
Selective Insurance Co. of America in Branchville, N.J., has found that sensitive management of workers comp claims can be good for customers and profitable for the business, said Neil F. Flaherty, assistant vp.
In recent years, Selective has taken several steps to heighten claims managers' sensitivity, including changing terminology so a claimant is now referred to as "an injured employee," which helped change the way claims managers approached them, he said.
The company also adopted a new mission statement for claims managers: "Prompt delivery of benefits to entitled employees that are required of employers by the workers compensation statute, in the most cost-effective manner."
His other key recommendations to reducing litigation include:
Provide prompt answers to employees' questions.
Start negotiations early.
Make prompt settlement offers and raise only substantive issues in litigated cases.
For state agencies, the best way to reduce litigation in workers
comp cases is to let injured workers know their state-mandated medical and wage-loss benefits will be provided with certainty, consistency and communication.
Those elements are like "a three-legged stool" that supports the effective operation of state workers comp agencies with low levels of litigation, Ms. Telles said.
An effective agency gives an employee certainty that a state's workers comp statute is clear about what employers are required to pay and allows benefits to continue as long as needed, she said.
There should also be consistency in terms of the benefits a state agency provides, as well as predictability in adjudicators' rulings, especially in cases of permanent partial disability.
A state agency also should provide for the communication of timely and accurate information through telephone hot lines, pamphlets and perhaps ombudsmen. The information should be available to workers, employers and other system participants.
Specific steps agencies can take to reduce litigation should include:
Providing timely and accurate information to system participants.
Initiating agency activities to help prevent disputes.
Establishing time frames for payers to pay or deny claims.
Paying permanent partial disability benefits, pending a final determination.
Providing a clear and understandable framework for valuing permanent partial disability.