Author, Jim Malone, Workers’ Compensation Claims Advocate, Rancho Mesa Insurance Services, Inc.

A work related injury can be a very traumatic event for the injured worker, but also for their
co-workers, employer, family and friends. Some injuries occur from a specific event when everybody knows the injury occurred. Other times, incidents occur during the work day, or repeatedly over time, where the employee needs to report these incidents, accidents or developing symptoms to his supervisor, manager, or human resource manager according to company protocol. 

Prompt reporting of a work injury is very important for the employer and their continued responsibilities. The employee reports the injury or accident to his supervisor, manager, or appropriate employer representative. The employer than has 5 days to report the incident to the insurance carrier.

Once reported, the employer can examine the scene of the accident and verify the mechanism of injury. Witnesses can be identified and their statements can be obtained. If the cause of the accident was another person, that person can be identified and their information can be obtained. If caused by a tool or apparatus, that tool or item can be removed from the work place and kept in a secure area for future reference. If caused by a dangerous condition, the condition can be corrected or barricaded to prevent additional injury. 

Work injuries usually result in instances where the injured worker reports the injury to their employer and they are interviewed and referred to an occupational medicine facility. There are companies that provide medical professionals that triage, the injury with the employee via telephone, or a visit to the workplace. The employee may be allowed to drive themselves to this facility or may have to be driven by a supervisor or foreman. The employee is instructed to provide the employer the Work Status form from the physician immediately after each and every examination or follow up visit.  If he is released to work, his employer needs the physician’s release to allow a return to work and if they are released to modified duties, the employer then determines if modified work is available. If modified work is not available, the employer than sends the injured worker home until his next visit or until modified work becomes available. 

When the injury is addressed, there are forms that need completed for the work related injury. The most important document is the DWC 1 Claim Form. This form MUST be provided to the injured worker within 1 DAY of when the employer knows of the injury. This form starts the claims process with the insurance company. It is a two part form where the employee completes the top part and the employer completes the bottom. Upon completion, the form is submitted to the insurance company and copies are provided to the injured worker and kept by the employer. The employer is then to complete the Employer’s First Report of Occupational Illness of Injury Report (ER’s 5020 form). Then, they obtain the Supervisor’s Report of Work Injury Report and any witness statements that may have been obtained. All these forms and reports are submitted to the insurance adjuster upon receipt and/or completion.

Now that the claim has been created, the employee is obtaining medical treatment, and all the forms have been completed and submitted, the employee’s progress will be monitoring during their recovery.  Maintaining good communication with the employee and claims adjuster is very important for helping the employee get through this recovery process. 

For additional information, please contact Rancho Mesa Insurance Services, Inc. at (619) 937-0164.