If a worker is injured on your job-site, the first thing you should do is ensure they immediately receive any necessary medical care. But what do you do next?
If you answered, “file a workers’ compensation claim with Builders Mutual,” you’d be correct. But that’s only half the story, because there’s a difference between filing and filing the right way – that is, promptly with the appropriate level of detail.
Randi Earp, Workers’ Compensation Team Lead at Builders Mutual, discusses three common mistakes policyholders make in filing their claims – and how you can avoid them to help your claim be processed as efficiently as possible.
Mistake #1: Delay reporting
Time is of the essence when filing a claim. Here’s why prompt reporting matters:
- Protect worker health. When a claims team learns too late about an employee injury, they lose time in reaching out and helping that person get appropriate medical care. Without the right treatment, that worker’s injury may get worse, further delaying their recovery and return to work.
- Lower claim costs. Injuries that worsen due to a delay in care can lead to increased medical costs. For example, Earp reports one case in which a worker hurt their foot, which left untreated turned into a serious infection. The worker eventually needed his toe amputated, racking up about $500,000 in medical expenses. Charges like these ultimately funnel into increased premiums.
- Conduct investigations effectively. The sooner a claims team knows about a workplace accident, the quicker an adjuster can investigate the incident. Investigators can gather evidence and record witness statements while the accident is still fresh. This helps to determine compensability and to mitigate potential fraud. What’s more, drug or alcohol tests can be conducted as soon as possible, which allows claims to be denied if the worker was under the influence.
- Prevent unnecessary litigation. If employees know their claim hasn’t been reported, they may seek the help of an attorney, which can lead to higher litigation costs hitting the employer.
- Avoid penalties and fees. Reporting workplace injuries is required by OSHA and each state’s workers’ compensation division. Failure to do so can result in hefty fines.
The quickest way to report a claim to Builders Mutual? Call our Claims Center at 800-809-4862. Or if you’d prefer, send an email to email@example.com.
Mistake #2: Not providing enough detail
However you contact Builders Mutual, it’s crucial that you provide all the information needed to process the claim properly. That includes basic information about the injured employee (e.g., name, date of birth, contact number) as well as the circumstances that led to the incident and the extent of the injury.
Armed with detailed files, your Builders Mutual adjuster can begin their investigation quickly. What’s more, claims teams can provide informed guidance to policyholders and workers. Getting the right care from the right specialist – for example, an orthopedist for a back injury – can help speed recovery and lower medical costs. In some states, known as “panel states,” Builders Mutual will provide injured workers a selection of three doctors to choose from.
Claims teams also need comprehensive information from policyholders to file the necessary paperwork with each state on the policyholder’s behalf, and to determine the appropriate benefit. If an injured worker misses more than the state-mandated waiting period – for example, seven days – then they are entitled to benefits that include lost wages. If the worker is out less time, the claim would only qualify for the reimbursement of medical expenses.
In some cases policyholders may choose to pay out of pocket for medical care that isn’t costly, since filing a claim could impact premiums. Nevertheless, Earp advises, it’s always best to inform Builders Mutual about the incident. These “record only” or “notice only” reports do not affect premiums, and are important to have on hand if a minor injury turns into something major down the line and the policyholder decides to file a claim then.
Mistake #3: Being unresponsive
During the claims process, the adjuster will undoubtedly have questions and the claims team will need to provide updates. If the policyholder doesn’t respond to these inquiries, the claim can’t move forward.
Earp recommends contractors designate an individual to oversee filing that initial claim and serve as a follow-up contact. Sometimes it can be a person in human resources or the safety director, or even the owner in small companies.
Injured workers also have a responsibility to be responsive, both to the claims team and their employer. Keeping both parties updated on their health – and following their prescribed treatment plan – will help ensure they continue to receive the care they need.
Answers when you need them
Accidents happen. When they do, the Builders Mutual Claims Department is ready to answer the call. Thorough and collaborative, we are committed to getting the best outcomes for your policyholders and their crews. Plus, we assign a single point of contact who handles the claim from beginning to end to make the claims process go as smoothly as possible.
Before an accident occurs, Builders Mutual can help prepare your teams to file claims properly by educating them on what forms to have on hand and where, for example, to handle timely drug testing. After a workplace injury, we can help arrange for care. Builders Mutual partners with MedCall to offer 24/7, on-demand, phone- and video-based emergency medical services to policyholders who may have experienced a workplace injury.
Remember, to file a claim, call us at 800-809-4862. Or, send an email to firstname.lastname@example.org. Policyholders may also contact their agent, who can help facilitate claims filing.