The U.S. Labor Department reported in May 2024 that 272,000 new jobs were added to the labor force. This significant increase naturally leads to a rise in workers’ compensation premiums due to higher wages and an increase in insurers’ market share. 

More relevant to this article, an increase in jobs creates a higher likelihood of workers’ compensation claims being filed, with the highest risk expected in the healthcare and construction industries. It is vital that both employers and insurers are aware of federal and state laws and regulations. They should be trained on handling injuries from initial reporting to required filings and internal procedures, and implement additional protocols and safety measures to reduce incidents and claims.

Legal and Regulatory Considerations

OSHA

The Occupational Safety and Health Administration (OSHA) is an agency within the Department of Labor responsible for ensuring safe and healthy working conditions for employees in the United States. OSHA creates and enforces regulations and safety standards that employers are required to follow. These standards include protective equipment, procedures, and environmental health standards. Legal and regulatory considerations pertaining to OSHA include:

• Training — Employers must provide comprehensive training, informing employees of job hazards and proper equipment use. This may include providing necessary protective equipment and training on its use.
• Record Keeping — Employers must maintain detailed records of workplace injuries and illnesses, as well as any OSHA inspections. These records must be kept for a specified period, typically five years, and be available to employees and OSHA inspectors upon request.

Failing to comply with OSHA regulations can result in serious repercussions, including fines, penalties, and even criminal charges. To remain compliant, employers should conduct regular safety audits and inspections, stay updated on regulatory changes, and adjust their safety programs accordingly. Although keeping up with changing regulations may seem daunting, it ultimately reduces workers’ compensation indemnity payouts and medical bills.‍

State-Specific Workers’ Compensation Laws

In addition to federal safety standards, each state has its own workers’ compensation laws and regulations. Employers must know which forms to file with their state’s workers’ compensation agency when an incident occurs. Most states require a first report of injury, but employers should check their state laws for proper procedures and time requirements for reporting incidents. 

Once the insurer is aware of the incident, they have their own filing requirements. They must determine if they need to make payment or deny the claim within a specified number of days and file the necessary forms for payment or denial, including any required medical evidence or formal statements.‍

Proactive Measures for Employers

Regulatory Compliance 

Employers must file accident reports promptly, as required by state laws. After an accident, they should file an accident report with the relevant agency and determine if the employee will be paid or denied. While the workers’ compensation insurer makes the ultimate decision, employers’ insights can help determine if the incident is a legitimate work-related accident requiring medical treatment.

After the initial decision to pay or deny, employers should fully investigate the matter. Cooperation with the insurance company is crucial to assist claims adjusters in making determinations.‍

Handling Employees

Employees must be trained on the steps to take following a work-related accident. They should provide prompt notice and fill out an incident report with detailed information, including contact details, incident description, witnesses, specific injuries, and any medical treatment sought.

Employers can reduce potential workers’ compensation claims by responding promptly to injured employees, providing assistance, gathering facts, and explaining the available system for injury care. Employers should document everything the employee tells them about the incident and follow up on medical treatment.‍

Training and Development

• Onboarding — Effective onboarding programs should include safety training and education to reduce the risk of workplace injuries. Ongoing training programs should keep employees updated on the latest safety protocols and procedures.
• Technology and Equipment — Workplace cameras and surveillance can corroborate incidents with no witnesses. Ergonomics training and ergonomically designed desks, chairs, and equipment can reduce musculoskeletal injuries, which are common.
• Job Transitions — Employers should have a list of transitional and light-duty jobs available to accommodate injured employees. This helps get workers back to work quickly, substantially reducing workers’ compensation claims costs. Employers should stay in contact with employees to assess recovery and set specific return-to-work expectations.
• Wellness Programs — Wellness programs for physical and mental health encourage employees to stay with the company and can reduce injury incidents.‍

Proactive Measures for Insurers and Claims Adjusters

Regulatory Compliance

Insurers should take immediate action upon receiving an incident report from an employer. They should gather facts, determine if a legitimate work-related injury occurred, and decide whether to pay or deny the claim promptly. Proper form filing is crucial to avoid costly delays and litigation. A thorough investigation should follow, including collecting medical records, conducting surveillance, speaking to witnesses, and consulting legal counsel.‍

Training

Adjusters should be well-trained in all aspects of claims handling through in-person classes, online courses, mentorship programs, and up-to-date manuals. Training should cover legal and regulatory requirements, initial claim setup, defining a work-related claim, compensability, medical terminology, medical disputes, earning capacity, returning to work, and other state-specific requirements. ‍

Prior Similar Incidents

Conducting an injury analysis, including reviewing past incidents, losses, and injuries, can help determine the causes of accidents and how to prevent similar ones in the future.‍

Healthcare and Construction

Healthcare and construction workers are prone to accidents and injuries due to the nature of their jobs, which often involve heavy lifting, powerful machinery, frequent mobility, and exposure to hazardous environments. An increase in jobs in these sectors could lead to more workers’ compensation claims. Employers should ensure proper safety equipment and gear, provide training, and develop detailed safety programs with ongoing improvements based on regulatory changes.‍

Common Construction Accidents

Falls are common among construction workers, so employers should implement guardrails, safety nets, and harnesses, and provide training on their use.

Electrocution injuries are also common. Electrocution safety techniques include “lockout and tagout” procedures to ensure electrical devices are switched off when work is being performed. ‍

Common Healthcare Accidents

Healthcare workers are more likely to develop musculoskeletal disorders compared to other workers. They also face risks from manual lifting, needles, sharp instruments, and liquids that can cause slip and fall accidents. Preventative measures include proper record keeping, handling protocols, and ergonomic equipment.‍

Recap — Keep Employees Safe While Reducing Exposure and Costs

• Reducing workers’ compensation claims requires ensuring a safe workplace. Employers should regularly evaluate workplace safety, provide safety gear, train employees on hazardous situations, and implement good ergonomics.
• Communication with injured workers is essential, including providing appropriate medical care and discussing return-to-work plans.
• Staying compliant with OSHA and state regulations is necessary from both legal and financial standpoints and for employee safety.
• Employers and insurers must be diligent in reporting requirements to reduce fines and violations.
• Claims adjusters should conduct thorough investigations to determine compensability, assess medical treatment disputes, and address factual disputes about incidents.
• Surveillance, background checks, and reviewing prior claims are recommended.‍