Workers Compensation Claims Checklist

The Workers Compensation Claims Checklist is available free below to download, customize and print for your church's Human Resources Dept...

Does your church or organization have employees?

If yes, then you might need the WC Claims Checklist below to help you in the unexpected event that one of your employees gets hurt on the job and need some benefits...

The Workers Comp Claims Checklist is a four page list that is very critical in handling workers' comp claims. Every organization with employees or business owner should be prepared for the day when an employee may be injured in a work-related accident. No matter how safe and careful your workplace is, accidents do and will happen. This checklist includes:

• Initial Response - The initial period is critical in handling workers’ compensation claims. Be sure to:
• Immediately - a) Administer first aid, b) Accompany injured worker to a selected medical provider, c) Report incident within company, d) Notify family, e) Assign responsible person to follow claim
• First Day - a) Report to claim handler outside company (insurance company or third party administrator), b) Determine, on a preliminary basis, whether the injury is covered by workers’ compensation, c) Counsel employee and/or family on claims procedures, available benefits, company’s continuing interest in employee’s welfare, etc., d)   Follow up with the employee or family
• First Week - a) Coordinate payment of initial benefits, b) Talk to treating physician to learn diagnosis and treatment plan, c) Evaluate whether medical rehabilitation is necessary or appropriate, d) Develop return to work plan, e) Forward mail, f) Contact the injured employee and/or the family
• First Month - a) Use a “wellness” approach (cards, phone calls, regular visits) to continue to reinforce company’s concern, b) Consider medical examination by independent physician, if warranted, c) Reevaluate treatment plan based on new medical information, d) Update return to work plan, e) Contact the injured employee and/or the family
• Ongoing - a) Continually reevaluate treatment plan, b) Update return to work plan, c) Refer to vocational rehabilitation, d) Refer to pain management evaluation of chronic pain, if appropriate, e) Maintain contact with the injured employee and/or the family
• Collection Information - Whether it’s the businesses owner, or someone assigned by the business owner to keep track of the claim, here’s some advice for the types of information the person overseeing the claim should be gathering:
• About the Employee - Name, nicknames, maiden name, previous name...(see checklist)
• About the Injury - Time and date of injury...(see checklist)
• About the Claim - Date employer first notified...(see checklist)
• Oral Statement from Injured Worker - Conduct the interview in a non-adversarial setting, Demonstrate concern and empathy...(see checklist)
• Written Statement from Injured Worker - Note the location where the statement is taken, Let the employee write the statement, if possible...(see checklist)
• Oral Statement from Witness(es) - Note witness’ location at the time of injury, Record witness’ relationship to the injured worker...(see checklist)
• Written Statement from Witness(es) - Make sure the witness writes the statement in ink, Record the stated ASAP after the injury...(see checklist)
• If Litigation Occurs - Defense attorney, law firm, Claimant attorney, law firm, Judge,  Cost of litigation (spending more than paying?),  History of dispute, Settlement

Workers Compensation Claims Checklist

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