Problem claims have few simple solutions. Each situation is unique and its response needs to be carefully tailored. But some rules of thumb can help make the best of a bad situation and avoid complications.
Don’t fire the employee.
A quick decision in the heat of the moment could make the problem longer, costlier and more troublesome in the end.
Take a step back, talk to others involved, and examine your choices and their costs. If you still decide termination is the right course, you’ll have made that decision knowing what to expect down the road.
Put personal feelings aside.
This may be difficult. But you want to make a decision that’s ultimately best for your organization overall, though it may not be the decision you’d personally prefer.
Be pragmatic about the short-term and long-term outcomes. Be realistic about how the employee will portray the situation, whether or not it’s accurate. Consider what’s at stake for your organization. How would the different outcomes affect all the people involved?
Good documentation may save you from expensive litigation.
- Every time you contact the employee, including what was discussed and when.
- All physician contact.
- Employee performance issues.
Contact the right people.
You’ll want to be in contact with the following people during the course of the claim:
- Employee: Never underestimate the power of showing concern for an injured employee. Claims often become difficult or can even go to litigation because the employee is off work and feels isolated and afraid. Fear leads to distrust, and that can lead to disputes. Send cards or flowers. Contact the employee early and continue to do so regularly. Explain transitional work. Let injured employees know they are valued and you want them back on the job. If they have personal issues, suggest your employee assistance program, if available.
- Claims representative: Besides experience in educating employers about the costs and consequences of difficult situations, SFM’s claims representatives have many resources available, including legal and medical professionals. When a problem situation arises, call your claims representative first, and always keep him or her in the loop.
- Employee’s physician: Beware of miscommunication here. The problem employee may misrepresent available transitional jobs to the physician or fail to return the Work ability/return-to-work form to you. If you have questions about work restrictions, call the physician. Convey to the physician your commitment to return-to-work and transitional duty. Legally, if you call the physician to discuss transitional work, you are obligated to verify the discussion and its substance in writing back to the physician and send a copy to the employee. This practice also improves accountability throughout the claim.
- Employment attorney: SFM gives policyholders legal advice from a workers’ compensation perspective, but you may need employment law advice as well.
- Agent: Your agent can explain what your decision will do to your e-mod, long-term insurance costs and long-term insurability.
Make the employee a transitional job offer.
This is one of the most important steps you can take to maintain good relations with the employee, decrease indirect claim costs, and increase your ability to settle the claim favorably.
When designing the transitional job, consider the employee’s work restrictions and be creative. Send a formal job offer letter to the employee’s residence.
If you haven’t heard from your employee in a reasonable time, call your claims representative. Wage-replacement benefits may be discontinued if the employee refuses a job offer within his or her medical restrictions. A sample job offer letter can be downloaded from the Resource Catalog on sfmic.com.
Make the best business decision for your organization.
Ultimately, you have to assess all aspects of the situation and do what you think best for your company. Workers’ compensation costs may be only one aspect.
If the employee’s behavior is harming your organization, you may decide that letting the employee go and risking the much larger potential costs is the better option. On the other hand, the circumstances may suggest that the prudent business decision is to work through the problems and avoid risking the costs.
Be proactive. Prevent these in the future.
Use good hiring practices. Deal with performance problems promptly. Make good employee relationships and teamwork a priority. Tune in to employee concerns and morale problems.
Be committed to safety: By preventing injuries you can prevent many problem claims while protecting your company’s most valuable resource — your employees.