When an employee is injured at work, your business goals and those of your insurance company coincide. This ensures that the injured employee is receiving the best possible medical treatment and returns to work as soon as possible. These mutual goals help control claim costs and ultimately the rates you pay for workers’ compensation coverage.

Reporting an employee injury as soon as you become aware of it is a key factor to controlling claim costs. Studies show that claims reported immediately to the insurance company had settlement costs significantly lower than those in which reporting was delayed.

Managing the Employee Injury
Managing an employee injury begins the moment the employer gains knowledge that an employee was injured, or may have been injured at work. Workers’ compensation regulations establish specific timeframes that employers and insurance companies must follow. Regulations define the employer as not just the business owner(s); the employer can also be a manager, supervisor or anyone holding a position of authority in the business. When the employer learns of an employee injury or alleged injury, the “clock starts ticking” for specific actions that must be taken. The employer can learn or gain knowledge of the injury directly from the employee, fellow employee, family member, or medical facility.

Once you have knowledge of a work related injury, you have one business day to give the employee an Employee Claim for Workers’ Compensation Benefit form (Form DWC-1), or mail the form to the employee’s mailing address. You have five business days to report the injury or illness to the insurance company, but the sooner the injury is reported the better. It’s important that you inform and train managers and supervisors about the claims reporting process.

When a Work Injury Occurs
When an employee is injured at work, follow these steps:
1. Initiate medical treatment. Transport the employee to the nearest hospital or medical facility if appropriate. An injured employee should never drive himself or herself to the hospital or clinic. For emergency or life threatening injuries, immediately call 9-1-1.

In non-emergency situations, initiate first aid treatment if necessary and work with your insurance company to find the nearest medical provider, preferably one that is in the insurance company’s Medical Provider Network (MPN)*.

*If your insurance company has a Medical Provider Network you are required to give the employee a second copy of the carrier’s MPN handbook at the time of the injury.

2. Call your workers’ compensation insurance company to report all work-related injuries and complete the Employers First Report of Injury form (Form 5020). If the injury appears to be a first aid only injury, tell your insurance company when reporting the claim.

3. Provide the injured worker an Employee’s Claim for Workers’ Compensation Benefit form (Form DWC-1).

4. Report to Cal-OSHA Enforcement within eight hours of occurrence, all fatalities, amputation of a body part, disfigurement, or injury/illness requiring hospitalization for more than 24-hours for anything other than observation. Failure to report an injury may result in a $5,000 fine.

5. Start planning for your employee’s return to regular or modified work and stay in contact with your claim representative.

Selecting an insurance company that is financially secure, specializes in workers’ compensation and is knowledgeable of California’s insurance environment can reduce the anxiety and stress that can follow an employee injury. These companies generally have a disciplined approach to workers’ compensation that is evidenced by strong relationships with medical providers, comprehensive injury management procedures--and most importantly, communication with you, the injured employee and medical provider.

A quality insurance company should also be able to provide you with effective safety and health services to help you prevent employee injuries, and assist with returning injured employees to work when medically appropriate.

To obtain a free five-step injury reporting poster, please call (888) 656-5678.