tecis

Compensability

Issues to be considered:

• Injury: There must be some element present, which can be legitimately regarded as an injury (or accident). There must be evidence that a bona fide event occurred to cause an injury. Ask yourself: Was there a specific incident (or action) to cause the injury, or was the employees performing normal job duties with no unusual occurrence present to specifically cause an injury. Keep in mind that simply alleging an ache, pain or strain may or may not qualify as a compensable injury-if there is no specific incident the problem may be personal.
• Course of Employment: The injury must have occurred under circumstances which can be accepted as being in the course of employment. Ask yourself: But for the fact that the employee was in the realm of his/her employment, would he/she have sustained the injury.
• Related to Employment: The injury must have occurred under circumstances which can be accepted as being in the course of employment, defined as furthering the interests of the employer. Ask yourself - was the hazard presented in the accident peculiar to the employment?

Details of the Accident

Issues to be considered:

• Date, time, place
• Was the incident reported immediately?
• If the accident occurred outside, what were the weather conditions?
• How soon was first aid administered?
• Did claimant go to the hospital?
• Did claimant return to work after receiving treatment?

Witness Statement

Issues to be considered:

• How many witnesses were there?
• What exactly did they see?
• Did they administer any assistance?
• Was first aid administered on the spot?
• Are any of the witnesses related to the claimant?
• Have you obtained all witnesses names, addresses & phone numbers?

Length of Employment

Issues to be considered:

• How long has the claimant been in your employ?
• If they are a recent hire, what do you know about the claimant's employment history?
• Was the claimant hired on a permanent or temporary basis?
• Do you know if the claimant has any prior workers' comp claims?
• If the claimant has been employed by your company for some time, are they close to retirement age?
• Is there any possibility of layoffs, plant shutdown, closure etc., in the near future?

Job Duties

Issues to be considered:

• How are the claimant's normal job duties related to their injury? How, exactly, is he/she precluded from working?
• Can any of these duties be modified to accommodate the claimant's disability?
• Is there a light duty position available for the claimant that they could easily perform?
• Have you discussed this issue with the attending physician?
• Does the claimant possess experience that would allow them to be placed in another position?
• Have you discussed, with the claimant, the possibility of retraining for another position?

Medical History

Issues to be considered:

• Did the claimant submit to a pre-employment physical? Checking your records may reveal an earlier injury of the same nature.
• Does the claimant have any pre-existing conditions, such as diabetes, epilepsy, etc., that will greatly hinder their ability to recover?
• Does your company have a policy of conducting pre-employment background screens?
  If so, depending on the type of background information your company looks for, your records may indicate that the claimant previously sustained the same type of injury in another capacity (for instance, an auto accident)

Jurisdiction

Issues to be considered:

• In what state was the employee hired? Do your records clearly reflect this?
• In the case of truck drivers, in what state is the employees' home terminal located? Is it the same state of hire?
• In what state does the employee permanently reside?
• In most jurisdictions, the state of hire is the predominant criteria for determination, but not always. If there is a question, all factors must be considered as to how they relate to the incident overall

Subrogation

Issues to be considered:

• What specific function was the employee performing at the time of the accident?
• Was the employee engaged in operating a specific piece of machinery or using any equipment, hand tools, etc.? Who owns said equipment, etc.?
• Were all safety precautions being observed at the time of the accident?
• If employee was off company premises, where were they and why were they there?
• Do you have the name, address, etc. of the owner of said premises?
• If employee is a driver, what type (age, model, etc.) of vehicle was he/she operating at the time of the accident? Who owns the vehicle?
• If a vehicle accident, what was the condition of the road and were any other drivers, pedestrians, etc. involved?
• If the answers to any of these questions lead you to believe that some type of hazard or malfunction contributed to the injury then the issue of subrogation should be investigated further.