By Donna Motley, Director of Claims

Late reporting of employee injuries can be costly in multiple ways.

We received a claim on August 16, 2013 for a July 3, 2013 injury date – approximately 6 weeks after the injury allegedly occurred. The employee said they “bumped” their elbow on a part. The diagnosis was “post traumatic olecranon bursitis”. The employee did not lose time from work. The employee treated for the condition on July 3, 2013 (the day of injury), July 8, 11, 22, 29, and October 8, 2013 when they were discharged from care.

Notice there were five visits with the medical provider before we even received the injury report. Per the Workers’ Compensation Act, the W/C provider/insurance carrier exclusively directs all medical treatment for the first 28 days! In this particular case, we lost that opportunity. Could we have shortened the length of this claim and thereby the amount spent – very likely!

Also notice, almost three months passed before the employee was discharged from medical care. That is because the employee did not plan on returning to the provider because they “felt fine”. WE insisted they return to the provider for a final discharge because if you do not have a final discharge in hand the employee can come back at any time and allege further complaints and we would have little or no basis to deny treatment/coverage.

We received another injury report on August 19, 2013 for an injury that occurred on August 20, 2012 – one year prior. The employee had a crush/laceration to two fingers. Fortunately there was no tendon damage, but the fingers were sutured. When the injury occurred in 2012, the employer did not file a claim with our office and paid for all medical treatment (without the benefit of cost containment). The employee was discharged from care on September 5, 2012. The employee did not lose any time from work as a result of this injury.

We were notified of the claim in 2013 because the employee was having continuing problems with a mass on the inside of their finger. The employee sought treatment with their primary care physician who referred the employee to an orthopedic specialist and surgery was proposed prior to us receiving the claim. We then had to request all previous medical records for review. The employee had surgery on October 31, 2013 to remove the foreign body/ mass and was discharged from care in December 2013. The cost of the surgery, after cost containment, was $3,379.14. The health insurance carrier paid for the visits to the PCP and Orthopedic specialist.

Technically, we could have denied coverage/treatment until after the surgery was performed and it was proven to be related to the original work injury. Surgery was delayed while we obtained all medical records. Again, it was fortunate the employee was able to continuing working during the investigation process.

Currently, we have had a couple of instances of injured workers contacting us direct, alleging a work injury and we have no notification of same from the employer. PLEASE BE AWARE, as an employer, just because you do not believe the injury occurred at your facility or you do not believe the condition is work related – it does not give you the right to NOT file a claim with your W/C carrier. The State can impose penalties up to $100 per day, against the employer, for failure to comply with the W/C Act and failure to report (and/or pay) for work related injuries. IF AN EMPLOYEE ALLEGES THEY WERE INJURED ON THE JOB – YOU MUST REPORT THE INCIDENT TO YOUR W/C CARRIER OR FACE POSSIBLE PENALTIES. If you do not believe there was a work related incident or have any other suspicion surrounding the claim, let us know and we will investigate for a possible dispute. We also utilize our Loss Control Department for investigations.