Workers’ Compensation: Quick Reporting Required With Employee Injuries

Whether it’s oral health care or practice management, it’s generally better to be proactive than reactive. This is certainly the case when it comes to maintaining a healthy, happy workplace. And when addressing employee injuries, being proactive is not just a recommendation — it’s the law in most states.

The Dentists Insurance Company reminds practice owners that employers are obligated to report workplace injuries immediately. Delaying such occurrences has the potential to not only further an employee’s injury, but to also lead to problems should a claim be filed at a later date.

The reasons for delay can be many. In some cases, the employer erroneously believes that reporting an injury will automatically increase their premium. In others, a well-intentioned employer attempts to handle the situation in-house. Most commonly, the employer takes a “wait and see” approach, hoping that the injury remains minor.

In one case reported to TDIC’S Risk Management Advice Line, an employee injured her back while reaching for something at work. The dentist requested the employee see a doctor, but the employee chose to take ibuprofen instead, confident that this would resolve her back pain. The next day, she was still sore, and the dentist again asked if she wanted to see a doctor. She declined and said she was fine.

Employers are reminded that once they become aware of a work-related injury, they should immediately contact their workers’ compensation carrier. The carrier will investigate the injury to determine liability.

The employee should be directed to an occupational medical clinic for treatment or a hospital for severe injuries. Some states allow employees to pick their own treating physician, while other states allow employers to direct medical care for work-related injuries through a network of approved physicians. Contact your insurance carrier for guidance on where your injured employee should seek treatment.

Unless otherwise predesignated, it is best that an employee avoids seeking treating with their own health care provider for work-related injuries. This can delay the claims process, the investigation of the claim and the benefits that the employee may be eligible to receive. Additionally, if an employer knows that their employee was injured at work but the employee refuses to follow state-mandated guidelines on reporting the injury and where to seek treatment, it is recommended that the dentist contact their workers’ compensation insurance carrier for advice. Employers have a legal obligation to report work-related injuries in a timely manner.

As part of the reporting process, it’s important to gather the facts of how your employee was injured. Ask your employee how they were injured, which body parts were injured and the type of injuries they sustained; for example, was the injury a strain, puncture, laceration, etc. This will play a vital role in the investigation of the employee’s claim and acceptance for workers’ compensation benefits. Your insurance carrier or assigned third-party administrator will need this information along with objective medical findings to determine the compensability of a work-related injury.

Workers’ compensation laws vary from state to state, but generally speaking, an employer must report the incident to their carrier within one business day of becoming aware of an injury. The U.S. Department of Labor has state-specific contacts and guidelines available on its website. It should also be noted that employers are required to authorize appropriate medical treatment and make medical care available to injured employees, regardless of whether the employers dispute the injury. Workers’ compensation claims are considered “no fault,” meaning the employee is covered regardless of the events that led to the injury.

In other workplace injury cases, practice owners are unsure of how to handle employees who request time off after becoming injured. TDIC reports a case in which an employee was injured after tripping and falling in the office. During recovery, she had been attending two weekly appointments — one visit to a doctor and the other to a physical therapist. The dentist called the Advice Line for guidance on whether he could ask the employee to take the appointments on certain days or times that didn’t interfere with his business operations.

The Risk Management analyst advised the practice owner that yes, he can ask, but he can’t refuse to allow her to attend her appointments if she is unable to schedule them outside of his business hours. However, if the employee fails to give adequate notice to her employer as outlined in the employee manual, she is subject to the same disciplinary actions as any other employee. In any event, everything should be documented, including the time-off requests, approvals or denials and doctors’ notes. This documentation should be maintained in a medical file separate from the employee’s personnel file.

It’s also important for practice owners to maintain open lines of communication with all parties involved in injuries — the employee, the carrier and, when applicable and appropriate, the doctor or medical staff. In another case reported to the Advice Line, an employee fell to the ground while walking. She said she didn’t know how she fell, but claimed her arm was hurting and went to the doctor. The doctor confirmed there were no broken bones and gave her a note to return to work. The employee refused to return to work, stating that she was in extreme pain and insisting on obtaining an MRI.

In this case, the analyst advised the dentist that unless the employee has paid time off, she must have a note from her doctor restricting her from work. Some dental practices allow employees to take unpaid leave; this is dependent on the office’s internal policy.

The dentist considered allowing the employee to take the time to obtain an MRI, as he was concerned that she would be unable to perform her duties at work. The analyst informed the dentist that he should refer the employee back to the workers’ compensation doctor for reevaluation to determine if work restrictions were necessary or if she should not be working at all.

Keeping open communication is also essential while the employee is on leave. The onus is on the employee to provide updates to the employer throughout the period of disability, and they should keep the employer apprised of an expected return-to-work date.

It’s also important that employers engage in open discussions with their employees regarding work modifications and accommodations. It is a good practice to allow employees to be on modified duty while they heal, if appropriate and approved by the patient’s medical doctor. All of these discussions should be documented in writing.

Even with the most careful precautions, employee injuries are an unfortunate reality in any workplace. Should an injury occur in your practice, expedient reporting to your workers’ compensation carrier is essential. Maintaining open lines of communication with your employee not only helps the claim process go smoothly, it is critical to mitigate further injury and ensure your employee is back to work quickly.