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| HSE DOCUMENTS-INJURY MANAGEMENT AND WORKERS’ COMPENSATION |
Table of Contents
1.0. PURPOSE
2.0. SCOPE
3.0. APPLICATION
4.0. DEFINITIONS
5.0. PREPARATION
5.1. GENERAL
5.2. FIRST-AID KITS
5.3. AUTOMATED EXTERNAL DEFIBRILLATORS
5.4. EMERGENCY SHOWERS AND EYEWASHES
6.0. INJURY CARE
7.0. CRITICAL INCIDENT
7.1. Response during the Incident
7.2. Response Following the Incident
8.0. CASE MANAGEMENT
8.1. Managers/Supervisors
8.2. Project HSE
9.0. RETURN TO WORK
9.1. Responsibilities
9.2. Liaison with Offsite Healthcare Providers
9.3. Return-to-Work Plan
10.0. WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROCESS — PROJECT/SITE/ OFFICE
10.1. Responsibility
10.2. Remobilization Alignment
10.3. Ongoing Communications
10.4. Medical Treatment Management
10.5. Injury/Illness Investigation
10.6. Employee Notification
10.7. Direct Loss Reporting
10.8. When to File a First Report of Injury
10.9. Extending Good Will
10.10. Claim Resolution
10.11. Delayed or Problem Claims
10.12. Suspected Fraud
10.13. File and Diary System
10.14. Post Injury Follow-Up
11.0. WORKERS’ COMPENSATION CLAIMS MANAGEMENT — CORPORATE
11.1. Adequate Proposal Information
11.2. Interface with the Insurance Provider
11.3. Reporting to Management
11.4. Medical Treatment
11.5. Claim Handling
11.6. Insurance Provider Performance Standards
12.0. CLOSURE OF PROJECT
12.1. Communication with the Insurance Provider
12.2. Project/Site Management
12.3. Communication with Healthcare Providers
12.4. Communication with Workers’ Compensation Group
12.5. Insurance Provider Closure Plan
13.0. PREPARING FOR EXPOSURE-BASED CLAIMS
13.1. Responding to Claims
14.0. RECORDS
15.0. RESOURCES
16.0. REFERENCES
17.0. ATTACHMENTS
1.0. PURPOSE
This technical methodology document explains the requirements for injury management and workers’ compensation for employees in a HSE DOCUMENTS office or on a project/site. This practice also defines the requirements for the management of the critical incident recovery process to minimize the negative emotional and physical effects on personnel following critical incidents.
2.0. SCOPE
This practice includes the following major sections:
- Preparation
- Injury Care
- Critical Incident
- Case Management
- Return to Work
- Workers’ Compensation Claims Management Process – Project/Site/Office
- Workers’ Compensation Claims Management – Corporate
- Closure of Project
- Preparing for Exposure-Based Claims
3.0. APPLICATION
This technical methodology document applies to work activities and employees under the control of HSE DOCUMENTS and its subcontractors.
4.0. DEFINITIONS
Critical Incident – Any situation faced by an individual that causes him or her to experience unusually strong emotional and/or physical reactions that can interfere with their ability to productively carry on with their everyday lives and that has a detrimental impact on the efficient productive operations of the project. A situation that could adversely affect the project or other areas of the company such as public perception.
Critical Incident Management – The professional management of personnel involved in a critical incident to facilitate their return to work as quickly as possible with the least emotional and physical effects.
Demobilization, Defusing, Debriefing – These provide opportunities for employees to express feelings, receive information, and to come to terms with what has happened, at appropriate times, as and when required.
Demobilization – The first opportunity occurs before returning to the site or home and is referred to as demobilization.
Demobilization provides an opportunity for employee involved with an incident to come together as a small group to make an assessment of their own personal feelings/stress reactions and to deal with them. During this session, they will gain further information regarding the status of the incident and possible emotional reactions they may experience, as well as how to get help.
Defusing – The second opportunity occurs 4 hours after the incident and is referred to as defusing.
Defusing provides an open and unstructured opportunity for confidential discussion by employees more seriously affected by the incident. It allows them to express their feelings and receive the help and support they may need to encourage the acceptance of what they have experienced.
Debriefing – The third opportunity occurs within 24 to 72 hours and is referred to as debriefing.
If the preceding opportunities are in place, then it is likely that debriefing may only be necessary for a small group of employees.
Debriefing is an intense and more structured form of the defusing process and will take longer (up to 3 hours or more). It is intended to further help those who have been involved to gain a clear idea of what has happened, release pent up emotions, and receive support and advice.
5.0. PREPARATION
5.1. GENERAL
The project/office must complete an assessment of needs regarding the care of injured/ill employees and fully implement the programs and processed deemed to be appropriate, in accordance with Practice XXXXX, Emergency Preparedness (Medical, Fire, Chemical, Weather).
To reduce the risk of transfer of infectious diseases, all personnel administrating first aid, or who have the potential of coming in contact with blood or other potentially infectious materials while performing their job functions, must follow the requirements in Practice XXXXXX (Blood borne Pathogens [BBP).
5.2. FIRST-AID KITS
First aid supplies must be approved by a consulting physician or medical providers.
When required on a project, first aid supplies will be readily accessible for all shifts and at each required location. If “Site” first aid services are not immediately available (such as off-shift, overtime, or remote locations), assign at least 1 person who holds a current first aid certificate, which is validated by record at training services, to provide emergency first aid for all shifts and at each required location.
Note: A valid first aid certificate may be acquired through the Site training organization or from recognized agencies such as the American Red Cross/UAE Red Cross.
First aid supplies with BBP kits will be readily accessible to the individual designated to provide emergency medical response. A documented, weekly inspection must be performed to ensure that no one has tampered with supplies — Form XXXXXX (or similar) should be used to document results. Ensure the kits are promptly restocked when used.
Note: First aid kits will be checked for a tagged seal; those tags used for fire extinguisher inspections are acceptable means of complying with the inspection requirement.
5.3. AUTOMATED EXTERNAL DEFIBRILLATORS
Because the use of automated external defibrillators (AEDs) can save the lives of workers who experience cardiac arrest while on the job, offices and projects are encouraged to consider making this equipment available in their workplace.
5.4. EMERGENCY SHOWERS AND EYEWASHES
6.0. INJURY CARE
If a work-related injury or illness is incurred:
- If the incident is an emergency, activate the location-specific emergency response system (for example, dial 911/999, etc.).
- Immediately after the incident or exposure, report the injury/illness to the immediate supervisor.
- Note: If unable to inform supervision right away, obtain medical treatment and notify supervision or management as soon as possible.
- If the project/office allows, and if the employee and manager/supervisor agree that the injury can be treated at the worksite (that is, one-time, uncomplicated treatment and subsequent observation of minor injuries such as scratches, cuts, burns that do not blister, splinters, or similar), the employee may self-treat the injury.
- If the employee or manager/supervisor determines that the injury requires medical treatment beyond what can or should be provided at the worksite, or there is a potential work-related illness with physical reactions (such as headache, burning/watery eyes, and coughing) the employee will report to the designated onsite first-aid or offsite healthcare facility.
- If the injury requires a higher level of treatment, the employee’s supervisor/manager must be informed to arrange an appropriate appointment and transport to an offsite healthcare provider. The employee’s supervisor/delegate must accompany the injured employee.
- When an offsite healthcare provider is seen as a result of a work-related injury or illness, a written release to return to work (Form XXXXXXX, Return to Work Notice, or similar) must be obtained, and supervision or management immediately notified.
- In the event the injury/illness worsens after work hours, obtain treatment then immediately inform supervision or management.
- Investigate, classify, record, and report the injury in accordance with Practices XXXXXX, Incident Reporting and Investigation, and XXXXXX, Global Information Management System – GIMS.
Note: Injuries/illnesses that are not work-related should be managed just like a work-related case, except the documentation should not be on forms suggested/required by this practice.
7.0. CRITICAL INCIDENT
A “critical incident” is one that involves lost time or is a fatality. A critical incident is considered a “major event,” and is reported in accordance with Practice XXXXXX
7.1. Response during the Incident
The Office, Project, or Site Manager will initiate the critical incident management process by notifying the person(s) identified in the Emergency Preparedness Plan (EPP).
- The designated person(s) will monitor the “emergency response team(s)” and other persons involved in the incident, and will activate support personnel as necessary for those affected emotionally.
- Immediate contact with families of seriously or fatally injured employees will be established, and support will be arranged.
- Families of employees involved, as well as other workers on site, will be notified of the status of the incident.
- The communications network identified in the EPP will be activated to enable access to updated information.
- Before returning to the office or site, or going home, an information and assessment process will be facilitated as part of the demobilization process; this will include information provided to employees and families on the subject of coping with major trauma or a major personal crisis.
- Persons in evacuated areas will be attended by support personnel to monitor their emotional responses.
7.2. Response Following the Incident
A. 0 to 4 Hours
- Provide onsite support for all personnel involved.
- If considered necessary by the designated person, arrange defusing sessions.
B. 5 to 24 Hours
- Provide support and information to all employees.
- Report the incident to Corporate HSE, Business Unit HSE Leads, and project (or office, as applicable) Business Unit management using Form XXXXXX, Major Events Report.
C. Short Term or Within 25 to 72 Hours
Where and when required:
- Organize debriefing in conjunction with the support person(s) who will conduct the sessions. Include all personnel affected (either directly or indirectly).
- Assess psychological state of affected personnel for further counseling and assistance.
- Issue all personnel information regarding coping with trauma or coping with a major personal crisis.
- If employees are hurt, make arrangements with the family and hospital to organize visits by employees in the work group.
- Should the incident result in a fatality, the relevant HSE DOCUMENTS Human Resources (HR) Manager must be contacted immediately so that arrangements can be made with the family to organize death notices/floral tributes, etc. Where practicable, all initial contact with the deceased employee’s family should be through the relevant HSE DOCUMENTS HR Manager.
- Provide support (such as childcare services) for all employees/families affected by the incident.
- Provide further facts to the work group and keep other personnel updated.
- Assist employees to resume work routines as soon as possible.
- Allow time for employees to attend funerals.
- The debriefers/support team will be debriefed.
D. Long Term
As appropriate, the Office, Project, or Site Manager – in conjunction with the designated person and support provider(s) – will provide the following:
- Follow-up counseling
- Meetings with all employees
- Contact with families involved
- Liaison regarding funeral arrangements
- Newsletter/letter to families of all employees – should be ongoing, and contribution from other employees should be encouraged
- Support for key persons such as line management, supervisors, and support personnel
- Ongoing liaison with outside agencies such as police and welfare
- Memorial services
- Support for debriefing team such as HSE staff and industrial chaplains
- Continuation of adequate counseling and support for affected personnel
- Continual monitoring of the behavior of those affected
- Change of work locations or job offered to affected employees, where warranted and possible
- Anniversary of the event recognized; consider memorial plaques as appropriate
- Assistance to employees’ families, as required; the family will initially be contacted every 3 months
- Effect on organization and productivity monitored and appropriate action taken
- Stress management courses offered for affected employees
8.0. CASE MANAGEMENT
Note: The following section – while not mandatory for contractors/lower tier contractors, unless otherwise noted – will be of great benefit in the overall process of injury management and workers’ compensation.
Note: In offices and on projects where HSE DOCUMENTS has the responsibility for the HSE program, the HSE DOCUMENTS HSE Representative must be notified and meet the employee and supervisor at the offsite healthcare provider location. The HSE DOCUMENTS HSE Representative will provide case management services for HSE DOCUMENTS personnel, as well as—to the extent possible—for contractor/lower-tier contractor employees.
8.1. Managers/Supervisors
Managers/supervisors should perform the following:
- Notify Project HSE and arrange to meet at the healthcare facility when an employee has reported an injury or illness.
- Accompany the injured/ill employee to the healthcare facility or local hospital emergency room whenever the employee is being assessed as a result of an occupational injury/illness.
- Follow up with the injured/ill employee to ensure reassessments are completed when scheduled, or earlier if appropriate.
- If an employee seeks offsite medical care, before allowing the employee to return to work, review the employee’s work release from the offsite healthcare provider.
- If an employee notifies you that he/she is unable to report to work because of a work-related injury or illness, arrange to meet the employee at the designated healthcare facility.
- (Mandatory) Notify HSE DOCUMENTS Project HSE immediately if there has been any change in the employee’s treatment, case status, or offsite medical or chiropractic treatment.
- In conjunction with healthcare providers, request additional medical assessment or diagnosis of occupational injuries/illnesses, if required.
8.2. Project HSE
Project HSE should perform the following:
- Meet the injured/ill employee and their manager/supervisor at the offsite healthcare facility.
- Upon arrival, evaluate the situation and decide if the manager/supervisor may leave.
- Interface with the injured employee and the healthcare provider regarding return to work options.
- (HSE DOCUMENTS Project HSE only) Communicate outcomes of incidents and changes to the Business Unit/Line HSE Lead(s).
- Maintain and manage incident data retrieval and reporting.
- Administer the workers’ compensation program.
9.0. RETURN TO WORK
9.1. Responsibilities
Consistent with medical advice, employers are required to assist employees to remain in the workplace or to return to work as soon as possible if injured or ill. This requirement applies equally to work-related and network-related injuries and illnesses. Specifically, the requirements usually include, but are not limited to, the following:
- Consistent with medical advice, actions to assist employees to stay at or return to work are taken as soon as possible.
- Provided it is safe and practicable to do so, injured or ill employees will be returned to work in the shortest possible time.
- If this is not possible, the employee will be returned to suitable alternative or selected duties that do not jeopardize their well-being or the well-being of others.
- Managers and supervisors will assist their employers in meeting these responsibilities, including where practicable, to immediately report all injuries to their immediate supervisor.
- The Project/Office Manager and each contractor will appoint a “return to work coordinator” who will act as liaison officer in all rehabilitation cases.
9.2. Liaison with Offsite Healthcare Providers
Initial contact with healthcare providers for rehabilitation or return to work plans may be through the supervisor or project/office return to work coordinator. This is to fully inform the healthcare provider of the project/office rehabilitation and return to work policy and the availability of alternate/selected duties for injured employees.
Permission must be obtained from the injured employee on Form XXXXXXX, Injury Management Authorization. Once obtained, the return to work coordinator will contact the healthcare provider to ascertain what restrictions apply in relation to the injured employee returning to work.
Ongoing liaison for rehabilitation/return to work plans will be through the appointed return to work coordinator. An injured or ill employee will be offered alternative/selected duties in order to keep the employee in the workplace.
Each contractor is required to contact the project return-to-work coordinator at the time of commencing work to explain the contractor’s rehabilitation/return to work program and the availability of alternative duties for their employees.
9.3. Return-to-Work Plan
A return to work plan will be established for employees unable to return to work for 5 days or more. The return to work plan will be jointly prepared by the employer and the injured/ill employee in cooperation with the treating professional. The return-to-work plan will be approved by the Project/Site/Office Manager or designee. The following details must be included in a return to work plan for injured/ill employees:
- Project name
- Project/office address
- Name, address, telephone number, date of birth, and occupation of the injured employee and the date of injury
- Name of return-to-work coordinator
- Name, address, telephone, and fax number of the primary offsite healthcare provider
- Completed Injured Employee Job Description (Form XXXXXX)
- An Offer of Suitable Employment (Form XXXXXXX) at the workplace if the employee cannot perform pre-injury employment
- Estimated date when the employee will be fit to return to work and the hours of work
- Date the return to work schedule will be reviewed
- Details of medical restrictions on capacity to return to work
- Rehabilitation services necessary to facilitate the employee’s return to, or maintenance at, work following the injury
- Details of other assistance or healthcare services that will be provided to facilitate the employee’s return to, or maintenance at, work following the injury
- Details of actions taken to reduce the risk of further injury once the employee has returned to suitable work following the injury
- Signatures of the injured employee and the return to work coordinator
Return-to-work plans should be scheduled for review approximately every 2 weeks after commencement of plan.
10.0. WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROCESS — PROJECT/SITE/ OFFICE
10.1. Responsibility
- Project/Office Management is responsible for overall compliance to this process. Management is also responsible for the following:
- Being aware of reasons for, and solutions to, the causes of under-funding or excessive workers’ compensation costs, including the following:
- Improper rating classification
- No proactive claims management process
- Failure to understand workers’ compensation
- Knowing how much money is at risk and is lost (refer to Attachment 04, Workers’ Compensation Claim Cycle)
- Regularly communicating with HSE Management and the Workers’ Compensation Group.
In conjunction with the Project/Office Manager, the Project/Site/Office HSE Representative will be responsible for administering the workers’ compensation claims management. This includes developing comprehensive management systems to increase incentives for the employee’s early and safe return to work. The key factor in returning injured employees back to the work environment is personal involvement of supervisors and peers while the employee is recuperating. It is imperative to let the employee know they are missed and that the company wants to be sure that their needs are met. For example, an injury occurs and the employee is unable to return to work. Management mails a personal card to reinforce concern over the employee’s well-being and return to work. This may be followed up with some sort of visitation program conducted by Project/Site/Office Management.
The following sections are directed toward cost avoidance in the workers’ compensation claims arena for HSE DOCUMENTS projects/sites and offices.
10.2. Remobilization Alignment
During the remobilization stage or when a project/site undergoes a management change, the manager must hold an alignment session with insurance provider claims representatives. During this session, the following must be discussed:
- Overview of local workers’ compensation statutes and rules
- Set up 24 hour reporting communication
- Set up monthly or quarterly claim review timetable, as desired or recommended
Establish contacts: 1 or 2 claim representative(s) per project/site
- Review the HSE DOCUMENTS claim management process
- Establish healthcare provider list:
- General practice
- Emergency room
- Orthopedic
- Neurological
Management must select area healthcare providers that have a track record of efficient and effective health care. The physician list should correspond to the insurance provider’s recommendations.
10.3. Ongoing Communications
The Project/Office Manager and the Project/Site/Office HSE Representative are responsible for maintaining communications with the following:
- Insurance provider claim representatives
- Local claim management
- Healthcare providers
- Regional HSE Management
- Workers’ Compensation Group
Project/Site/Office Management and the Project/Site/Office HSE Representative are responsible for becoming familiar with the local workers’ compensation board or commission and learning how it operates. The insurance provider claim representative should provide assistance.
10.4. Medical Treatment Management
When an employee is injured on the job and is physically able, the employee is responsible for notifying his/her supervisor immediately and reporting to the onsite first aid facility for treatment. Failure to report injuries may result in disciplinary action.
The work-related injury/illness must be reported to the insurance provider within 24 hours of occurrence. The insurance provider must pre-approve all nonemergency visits. The insurance provider must also pre-approve all requests for second opinions.
10.5. Injury/Illness Investigation
A complete investigation of all work-related injuries/illnesses must be conducted as soon as the injury or illness is reported to the company as required in Practice XXXXXX.
10.6. Employee Notification
All employees must be notified in writing (employee handbook or official employee bulletin board) of the following:
“In order to file a workers’ compensation claim, employees should complete, date, and sign relevant workers’ compensation claim forms and turn the completed form in to their supervisor within 8 hours of the incident. Employees should then contact the company representative within 48 hours to date and sign any workers’ compensation claim if a work-related injury/illness is being claimed.”
Note: Individual insurers, states, and foreign countries may require specific language that differs from this paragraph; in such case, the required language is used.
10.7. Direct Loss Reporting
Workers’ compensation claims must be reported using the best and fastest methods available-Workers’ Compensation Claim Reporting).
Insurance industry studies conclusively show that the sooner a claim is reported to the insurance provider, the lower the overall cost of the claim. Early intervention of insurance provider claim representatives to manage costs is the reason for this.
10.8. When to File a First Report of Injury
A “first report of injury” (or other appropriate injury report form) must be filed when an injury or claim has obviously occurred while the employee is on the job or if it can reasonably be inferred the complaint is related to employment.
If an employee tells a supervisor “in passing” about an injury, pain, ache, or condition but does not believe it is work-related, the supervisor should document the complaint in the employee’s HSE file. If the employee later claims the complaint is work-related, the supervisor should file a “first report of injury” (or other appropriate injury form) along with a copy of the earlier documentation.
10.9. Extending Good Will
In all lost workday cases, Project/Site/Office Management must contact the injured/ill employee to extend good will. The HSE Representative will coordinate periodic management contact with the employee.
10.10. Claim Resolution
The Project/Site/Office HSE Representative is responsible for pursuing the resolution of claims. Close interface with injured employees, insurance provider claim representatives, and HSE DOCUMENTS’s Workers’ Compensation Group will be required.
10.11. Delayed or Problem Claims
Project/Site/Office Management will follow the progress of the claim to encourage and support timely handling by the insurance provider. Any delays, problems, or unsatisfactory claim handling must be reported to the Regional HSE Lead and to the Workers’ Compensation Group.
10.12. Suspected Fraud
Project/Site/Office Management and HSE must immediately report suspected fraud to the Workers’ Compensation Group and to the Regional HSE Lead. Being cognizant of fraud in workers’ compensation claims and reporting cases of suspected fraud or abuse to the Workers’ Compensation Group reduces insurance costs.
10.13. File and Diary System
A file and diary system must be established to record pertinent information concerning a claim such as contacts with an injured or ill employee. The file must be kept on the project/site or office (as applicable) and updated in a timely manner.
These files must be sent to the Workers’ Compensation Group upon project/site shutdown. The Workers’ Compensation Group will then assume the responsibility for updating the files.
10.14. Post Injury Follow-Up
A modified work recovery program will be planned based upon the employee involved. The decision to offer the employee another position or modified work duty will be made with active involvement of both the primary healthcare provider and the Business Unit HSE Lead.
11.0. WORKERS’ COMPENSATION CLAIMS MANAGEMENT — CORPORATE
The Workers’ Compensation Group — residing organizationally in Corporate HSE — was created to help lower HSE DOCUMENTS’s workers’ compensation costs and improve HSE DOCUMENTS’s competitive position. The Workers’ Compensation Group is responsible for the following:
- Provides adequate and accurate proposal information if available
- Supplies projects/sites with needed workers’ compensation resources
- Develops and maintains a “people-sensitive” program for injured workers
- Maintains a close interface with the insurance provider
- Maintains a proactive workers’ compensation management program
- Reports to all levels of management
- Follows up on claims for completed projects/sites/office to reach reasonable conclusions
11.1. Adequate Proposal Information
The Workers’ Compensation Group will evaluate funding methods by reviewing the projected premium and claims costs in a particular area. The Workers’ Compensation Group can create a project/site-specific proposal recommendation.
11.2. Interface with the Insurance Provider
The Workers’ Compensation Group will conduct an ongoing review and audit of the insurance provider and broker performance.
11.3. Reporting to Management
The Workers’ Compensation Group is responsible for being a single information-reporting source. The Workers’ Compensation Group produces and distributes confidential reports to:
- Executive level
- Business units
11.4. Medical Treatment
The Workers’ Compensation Group performs the following:
11.4.1. Seeks the insurance provider’s assistance in selecting the most qualified healthcare providers. Preferred providers (PPOs) should be selected where available.
11.4.2. Manages medical treatment of injured employees. This includes verifying that medical appointments are kept and obtaining reports on the employee’s progress.
11.4.3. Contacts injured employees personally after a work-related injury to encourage a speedy return to work and to show compassion and concern.
11.5. Claim Handling
The Workers’ Compensation Group performs the following:
11.5.1. Establishes communication with local insurance provider claims management to maintain satisfaction, including communicating orally and in writing to manage claim costs.
11.5.2. Concentrates on the cost containment of open claims.
11.5.3. Monitors claim handling by the insurance provider and reports unsatisfactory performance to the Workers’ Compensation Group for investigation.
11.6. Insurance Provider Performance Standards
11.6.1. Projects/sites/offices are expected to conduct their workers’ compensation business with insurance providers on a regional office concept. Therefore, Project/Site/Office Management should be aware of the insurance provider’s performance standards.
11.6.2. Insurance provider claims representatives must attend a project/site startup meeting with Project/Site/Office Management. The benefits of personal contact versus phone contact and the procedure for investigation of claims must be discussed. Also, the insurance provider must abide by Workers’ Compensation Group performance standards for insurance providers and maintain a spirit of “partnership.”
11.6.3. Within 24 hours of receipt of notice, all “time lost” claims must be assigned and initial contacts completed.
11.6.4. The insurance provider must be committed to the avoidance of attorney involvement.
11.6.5. The insurance provider must provide prompt and thorough investigation of claims.
11.6.6. The insurance provider must pay benefits in a timely manner to injured employees and healthcare providers.
11.6.7. The insurance provider must provide personal contact to injured employees when necessary.
11.6.8. When requested, and if appropriate, the insurance provider will assign one or more claim representatives to handle claims and thus avoid confusion and delays in communication.
11.6.9. When requested, insurance provider claim representative(s) will make periodic project/site/office visits to give claim updates and suggestions.
If any of the above standards are not met by the insurance provider servicing your region, contact the Workers’ Compensation Group for assistance.
12.0. CLOSURE OF PROJECT
Studies show that before the closure of a project or a plant, companies sometimes face a significant increase in workers’ compensation claims activity. If not prepared, a company’s insurance costs can escalate and its community relations can suffer.
12.1. Communication with the Insurance Provider
During the closure stage of projects, Project/Site Management must communicate with the insurance provider so that the insurance provider can act quickly in the event of questionable claims.
12.2. Project/Site Management
Project/Site Management must perform the following:
12.2.1. Insist that the most qualified and experienced insurance provider claim representative coordinates activities and handles claims coming at the closure of a project/site. Frequent and regular project/site visits by the insurance provider claim representative are necessary.
12.2.2. Supply the insurance provider claim representative with all claim documents such as wage statements and job descriptions.
12.2.3. Identify where all of the insured records including personnel files, payroll records, medical records, job descriptions, regulatory department inspections, and unemployment records will be stored.
12.2.4. Identify the location of complete histories of all employees. This includes date of birth, job titles, and department, and immediate supervisor, exact dates of hire, termination or last day of employment, and cause for termination. This information should also indicate which ones filed for unemployment benefits and on what dates.
12.2.5. Provide a complete description of all jobs, including lifting procedures, weights of objects, repetitive tasks, and occupational exposure.
12.2.6. Identify HSE DOCUMENTS Corporation personnel who will have direct access to personnel and payroll records and provide addresses and telephone numbers. These personnel should belong to management and be able to discuss the employee’s records in detail. In-depth knowledge is necessary in the event that court testimony is required.
12.2.7. Provide a copy of the project organizational chart to the insurance provider claim representative for potential witness information.
12.2.8. Provide the insurer with forwarding address and phone number.
12.3. Communication with Healthcare Providers
Project/Site Management must notify healthcare providers so they are aware of project/site closure. Project/Site Management must insist that, whenever possible, medical treatment be concluded to avoid lingering claims.
12.4. Communication with Workers’ Compensation Group
Project/Site Management must verify that the Workers’ Compensation Group is aware of pertinent details related to closure. Project/Site Management must transfer all files and diaries upon closure. The Workers’ Compensation Group will then assume the responsibility for updating the file.
12.5. Insurance Provider Closure Plan
In some circumstances, the insurance provider may prepare a detailed closure plan. This plan should document techniques for dealing with negative results that may accompany the reduction of a company’s workforce and the closing of one of its projects.
The plan focuses on reducing the number of claim reports and on preparing to defend the company against a marked increase in workers’ compensation claims. Since the intention is to reduce expenses while maintaining overall good will, cooperation is vital between the insured, the agent, the claims staff, and those employees directly affected by the layoff.
13.0. PREPARING FOR EXPOSURE-BASED CLAIMS
If the insurance provider anticipates a number of exposure-based claims, it may commission an industrial hygiene survey of the site/office, which focuses on noise, gases, chemicals, etc. The insurance provider may also prepare a detailed site diagram, which indicates the locations of various work areas and potential exposures.
The insurance provider may also select experts in specified fields consistent with the exposure and types of claims expected. The experts will be able to examine, evaluate, and investigate employee allegations.
13.1. Responding to Claims
The insurance provider will respond to claims by using the following procedure:
13.1.1. Obtain detailed and specific allegations, which have been prepared by either the employee or his/her attorney. This information includes work history (before and after date of loss), wages, name of immediate supervisor or other person who should be aware of his/her exposure, complaints and limitations, employment dates, medical history, and subsequent employment history.
13.1.2. Obtain a detailed statement (recorded or signed) from employee’s immediate supervisor(s) who knew or should have known of employee’s exposure, complaints, and limitations. Exact information details include occupation, employment dates, job duties, working environment, specific areas where employee worked, specific duties and exposures on an hour-by-hour basis with respect to proximity to noise-making operations, pollutants (if any), ventilation systems, use and availability of HSE equipment, and employee’s training and experience in use of equipment or machinery.
13.1.3. Obtain a copy of regulatory department reports, which may have a bearing on the defense of the losses.
13.1.4. Reviews personnel files to screen employee’s work history. This includes jobs held, dates of employment, termination date and reason, copy of unemployment benefit application with dates of filing, name of subsequent employer, information on medical claims, copies of forms, and information on prior compensation claims and awards.
13.1.5. Obtain copies of claim petitions ever filed by the employee so those similar allegations can be compared.
13.1.6. Investigate the employee’s knowledge and extent of outside employment, avocations, or hobbies.
13.1.7. Arrange an expert medical examination after providing complete background medical and lay information on the employee. Depending on the nature of the injury/illness and/or disability alleged, consideration should be given for more than one examination for each area of medicine.
13.1.8. Checks employee’s activities subsequent to filing of the claim. Areas to investigate are employment, hobbies, social activities, recreation, and any activity that may have a bearing on the defense of the claim.
14.0. RECORDS
Records must be managed in compliance with 29 Code of Federal Regulation (CFR) 1910.1020, and in accordance with Practice XXXXX, Records Management.
15.0. RESOURCES
Global Standards
- Australian Government Safety and Compensation Council; List of National Codes of Practice
- Safety and Compensation Council; List of National Standards
- European Union European Agency for Safety and Health at Work
- United Kingdom Construction Regulations 2007
16.0. RELATED COURSES
- Injury Management and Return to Work
- Basic First Aid Technique
- First Aid for Medical Emergencies
17.0. REFERENCES
- Emergency Preparedness (Medical, Fire, Chemical, Weather)
- Incident Reporting and Investigation
- Global Information Management System – GIMS
- Records Management
- Eating and Sanitation Facilities
- Bloodborne Pathogens
18.0. FORMS
- Return-to-Work Notice
- Injured Employee Job Description
- Major Events Report
- Injury Management Authorization
- Offer of Suitable Employment
- Project Incident Log
- Daily First-Aid Record
- First-Aid Kit Inspection Report
- Employee Exposure and Medical Records
19.0. ATTACHMENTS
- Recommended Contents for First-Aid and Blood borne Pathogen Kits
- Injury Management Process Flow Diagram
- (Critical Injury) Sample Letter to Employees
- Workers’ Compensation Claim Cycle
- Frequently Asked Questions
- Workers’ Compensation Claim Reporting
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