 What happens if a claim is disputed:
The insurer or claims agent may make the decision to assess or dispute the claim. It is important to learn what is involved and how to manage the process so the claim can be thoroughly assessed.
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1. The supervisor's role
The supervisor's response to an injured worker is one of the most important influences on the quality and speed of the worker's recovery and return to work. Don't expect supervisors to understand this, or that they know how to deal with return to work. Find out about the supervisor's competencies in this area and support them where necessary, including in understanding the importance of their role:
An effective supervisor:
| • | Listens to the employee's issues, concerns and needs |
| • | Will already have a relationship with the employee that allows them to discuss return to work |
| • | Leads the process by offering useful duties, working with the employee to sort out meaningful tasks |
| • | Keeps in touch with the employee, e.g. Calls them at home if off work, checks in on them during the day if at work |
| • | Identifies barriers to communication and is able to overcome them |
| • | Plans and facilitates the work duties until the condition has settled |
| • | Communicates with the employee if things are not progressing satisfactorily |
| • | Recognizes differing behavioral needs and expectations of people and is able to deal with these differences |
| • | Suggests ways the job can be modified to accommodate the employee's condition, e.g. have the person run a machine, but help out with occasional lifting |
| • | Doesn't mollycoddle the worker |
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2. Getting all the relevant information
Most information will be to hand by the end of the first week. If there is any doubt check with the employee or other staff yourself. It is easy for situations to be misunderstood and this can lead to long term problems.
For example, the line manager might advise that the person was not doing the type of work reported to cause the condition. Armed with that information claims staff at the insurer may consider disputing the claim. Checking the facts to ensure accuracy in the first place is vital, an unnecessary dispute is one of the most common ways to get the worker offside. If the facts are wrong, time and energy has been misspent, the employee will feel they are not believed, not trusted. Like begets like.
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3. Communicating with all parties
Employee
Set up regular times to catch up with the worker
Let them know who to contact if they have a concern, e.g. supervisor, HR, production manager
Tell them it is important they communicate
Advise them who to call, or speak to if there is a problem; provide back up contact personnel in case the first person is not available
Explain the claims process and offer the relevant forms
Let them know what the company's policy is on work disability
Let them know that their responsibilities regarding return to work are:
| • | Attend work consistently |
| • | Comply with rehabilitation endeavors |
| • | Be a positive part of the process |
Supervisor
Is the supervisor satisfied with the case progress?
Do they need additional support or back up?
Do they have an adequate understanding of:
| • | How long the restrictions will be needed |
Are co-workers being helpful, is further communication required in that context?
Treater
Keep it simple
Put it in writing if necessary, by fax, email or letter
Be clear about the company's support for the worker
Ask for clarification when needed. Make sure you understand.
Claims manager
Keep them up to date on communication with the worker. Provide all documentation in relation to the claim.
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4. Agreeing on duties
A team approach is best, include the worker by asking them what they think they can handle. Keep in mind that it is better for the worker to remain with their normal co-workers if possible. It is best if the worker's duties are a useful contribution to their work team and the workplace. Think outside the square if necessary.
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Next:
What happens if a claim is disputed?
