The Four Litigation Triggers that Stall New York Workers Compensation Insurance Claims

Posted by John Cofini on Tue, Oct 16, 2012 @ 02:39 PM

As an employer, you know that costs can skyrocket when disputes arise and attorneys get involved in your New York workers’ compensation claims. Litigation can easily become a part of almost any claim and quickly start draining resources. Some New York workers’ compensation claims are naturally more complex, but when litigation is involved, even the simplest claims can become complex. Months, and sometimes even years, of legal wrangling skyrocket claims expenses and increase your workers’ compensation premiums for years to come.

Four NY Work Comp Litigation Triggers and How You Can Avoid Them: 

  1. An unrealistic injured worker: In the absence of correct information, an injured worker can assume that a workers’ compensation claim adds up to a big pay day. He or she may assume that it’s necessary to hire a lawyer to get benefits that are rightfully owed. The easiest way to avoid this situation is to preempt it with a proactive, positive communication strategy. When an employee is injured, the first priority is to secure appropriate medical treatment. The second priority is to communicate with the worker about temporary disability benefits and return to work expectations – in a clear, caring manner. Workers who feel valued (and not blamed) are less likely to litigate. If they understand the process up front, realistic expectations can be established. It’s a good idea to work with your insurance partner to develop a “Frequently Asked Questions and Answers” sheet to give to every injured worker. 
  2. A difficult employer: Sometimes the employer unknowingly prompts litigation. Maybe the employer has a personal beef with the injured worker. Perhaps the employer wants to make an example out of the employee to discourage others from filing a New York workers’ comp claim. Or, in some cases the employer may legitimately believe the claim is unwarranted, fraudulent, or that the injury is caused by a preexisting condition. Making these feelings known to the injured worker is a recipe for disaster. If you have an issue with the claim, tell your claims adjuster. When you interact with the injured worker, your most important goal is to get the person back to full health and full work as quickly as possible to contain claim costs. With this goal in mind, it’s important that you are friendly, helpful and non-confrontational.
  3. A stubborn adjuster: On the other side of the coin, employers sometimes encounter claims adjusters who are stubborn about settling claims. If the adjuster isn’t being realistic or following your wishes, he or she can cause you headaches and drag a claim down. If this occurs, contact the claims manager or your insurance agency to discuss your concerns. In some cases, the claim may need to be reassigned.                                      
  4. Exposure to law firm advertising: When an injured worker goes home, hits the couch and turns on the television, several negative developments can occur. The injured worker can start feeling unproductive and depressed, he or she can get hooked on daytime television and lose motivation to return to work, and worse yet, he or she WILL be exposed to hundreds of personal injury law firm ads, planting the seed that legal representation is necessary to get benefits that are rightfully owed. What can you do about these risks? You can make sure the employee never hits the couch by offering early return to work! Create a light duty job for the injured worker, get it approved by the treating doctor and get the employee back to work right away. Injured workers who keep working resolve their injuries and claims faster.

In summary

As an employer, you obviously can’t control everything that might bog down a New York workers’ compensation insurance claim. But by being fully engaged at every step, you can greatly improve the speed of claim resolution. Start by hiring smart, training a safe workforce, reporting and investigating claims immediately, and having a robust modified duty/RTW program in place. And at every step of your New York workers’ compensation claims, communicate regularly with all parties involved.

If you’re dealing with a stubborn adjuster, speak up and voice your concerns. Talk to their supervisor if necessary. Get the problem solved, even if it means getting a new adjuster. Your carrier and adjuster work for you, and it’s their job to act in your best interest.

When attorneys get involved in a claim, you need to be even more engaged. Don’t let the adjuster merely pass the case on to the defense attorney and forget it. Make sure you and the adjuster hold the reins on and force issues to be addressed in a timely manner. Ultimately, you’re the one who suffers the consequences of an unfavorable legal outcome.

Unfortunately, litigation is an unavoidable fact of life in some New York workers’ compensation insurance claims. By following best practices, staying engaged, communicating regularly, and being prepared for litigation, you can stop the profit drain!

Would you like more information about New York workers’ compensation insurance cost saving options? Click to download our free report, “Why You Should Consider a Safety Group for Your New York Workers’ Compensation Coverage.

Tags: New York workers’ compensation, New York workers’ compensation claims, New York workers’ compensation premiums, NY work comp, New York workers’ comp