A broker's involvement may help make a difference in the outcome of an insurance claim. Your Cosmos account executive is not just responsible for arranging insurance coverage. Your account executive is also responsible for coordinating claims management services. We assist our insureds with the administrative aspects of reporting claims to insurers and monitoring claims handling with the insurance company adjusters. We can act as your advocate to assist with the negotiation and resolution of difficult claims and coverage issues. We can help you organize strategies to identify and solve claim-related problems such as pre-loss hazard identification, post-loss claims investigation and management, and related internal communication issues.
WHAT SHOULD YOU DO WHEN A WORKER GETS INJURED ON THE JOB? SOME QUICK TIPS --
Getting hurt at work is always stressful for the injured
worker. It is also stressful for the company managers, including how to report
and handle the new worker's compensation (work comp) claim.
Here are some of the key things to keep in mind:
Get immediate medical care for the injured employee. Do not wait
for a claim number to send an employee for medical treatment. It is never
necessary - just get the injured worker to the correct level of medical
treatment as soon as possible after learning of the new injury.
Some states permit the employer to direct the injured employee to
a certain doctor or panel of medical services from which the employee chooses. This
is critical in controlling costs and getting the employee back to work faster
than if he/she chooses their own doctor(s). If you are not certain about this,
please contact your AE at Cosmos Services.
Direct report the new injury to your work comp insurance company
as soon as possible. Don't wait for bills or anything else. And don't report
the new injury through the broker.
Numerous studies have shown that the faster a claim is reported, the better the results: employees return to work faster, lower claim costs, etc.
The best practice, based on insurance industry analysis of claim costs, good resolutions and so forth is for employers to report new work comp claims directly to their insurance company as soon as possible. However Cosmos Services is always available to you to assist or even report a new claim for you.
After the claim is reported to the insurance carrier - or at the
same time it is reported, let us know so we can help answer questions or
promote communication between the insurance claim adjuster, you the employer,
and the injured employee.
"Freeze the facts” by conducting an initial investigation as soon
as possible following the injury event. The purpose of the incident
investigation is to determine all the factors that contributed to the injury;
secure witness statements or take photos of the accident scene if either is
appropriate; and so forth.
Investigating quickly ensures that facts
will not get lost or changed; people's memories will not get confused or faded.
The purpose is not to find fault (to blame anyone). Rather, it is to know
& understand why and how an injury occurred which can help prevent similar
injuries and problems in the future.
If possible, it is important to offer alternative work within the
temporary medical restrictions. This helps speed-up healing while reducing the
insurance work comp payout reduces the cost of temporary workers, and so forth.
If you don't have any alternative work within the employee's
temporary medical restrictions, you should at least stay in touch with the
employee, calling them once each week or so to see whether the employee is medically
authorized off work. It helps them feel valued by their employer and also that
they have a responsibility to heal and return to work.
When submitting medical bills to the insurance company, always
write the insurance claim number for the injured worker on the bills. This
helps reduce matching errors (putting the bill with the correct claim file
& claim adjuster) and speeds processing (review and payment or request for
more info).
Should you have any questions or want more information, please contact Mark E. Pulsifer. He is an Account Executive in our Midwest Branch office (Chicago). He has over 20 years experience handling claims and dealing with risk and safety management issues. His email is mpulsifer@cosmosame.com.
Note: Although we can assist you with your claim as noted above, Cosmos cannot offer any guarantees of any kind, express or implied, that Cosmos claims management or any other services we provide for an insured will achieve a specific result, including, without limitation, whether an insured will receive any claim payment or monetary savings or payment for loss or damages. Nothing stated herein is intended to supersede or replace any provisions of the actual insurance policies and the coverage and risks underwritten by those policies. Insurance policies contain many conditions, exclusions and other terms which are not explained or described in this summary which is only for general information purposes. You must always review the actual insurance policies for the precise wording of the coverage, terms, conditions and limits which apply to you and your particular insurance.
A broker's involvement may help make a difference in the outcome of an insurance claim. Your Cosmos account executive is not just responsible for arranging insurance coverage. Your account executive is also responsible for coordinating claims management services. We assist our insureds with the administrative aspects of reporting claims to insurers and monitoring claims handling with the insurance company adjusters. We can act as your advocate to assist with the negotiation and resolution of difficult claims and coverage issues. We can help you organize strategies to identify and solve claim-related problems such as pre-loss hazard identification, post-loss claims investigation and management, and related internal communication issues.
