SAFE-Mail
A Workers’ Compensation News and Information Resource State Accident Fund | Volume 14, Issue 4 | Winter 2010 | www.saf.sc.gov
What Should an Employer Do To Investigate a Claim Peggy Urbanic, Clawson and Staubes One of the most important parts of claims handling is the initial investigation. In the initial investigation the key facts and witnesses are identified, defenses or mitigating factors are identified, potential exposure is minimized and benefits are timely provided to injured employees. So often the question comes up from the employer about what they can do to investigate a claim, particularly in cases where compensability is an issue. While most claims are legitimate, every now and then there is a question about whether the employee was injured on the job. I recommend that every employer has a system that they follow for each and every claim. Each employer should have a designated workers comp person who is responsible for the investigation and in large organizations the front line supervisors should also be trained in how to handle a report of an injury. If there is an issue of compensability, the earlier the investigation is done the better, and the employer is typically in the best position to do the initial investigation. The most important thing to remember is to document the claim and the investigation in writing. So, often the employer is adamant that the injured worker didn’t report the accident or a body part but there is nothing in writing to support the employer’s position. Typically, most, if not all, Commissioners when faced with the situation of the injured worker testifying one way and the employer the other way will side with the worker. So, what needs to be documented? In short, EVERYTHING! Document when the accident was reported, who the accident was reported to, and, if there was a delay in reporting the accident, what is the reason for the delay. Although employees have 90 days to report an
injury, often if an injury isn’t reported quickly it may raise some questions about what happened. Document how the accident happened, the more detail the better. Have the worker prepare a written statement of what happened and what body parts were injured. Often times one body part is admitted and months later an injured worker claims that they verbally reported additional body parts. Good documentation can help clear up any dispute over which body parts were injured. If the injured employee identifies witnesses, have the witnesses provide a written statement of what they saw and heard. If it seems unusual that no one witnessed the accident, interview the injured worker’s coworkers and take their statements. These statements maybe important later on in defending the claim. Depending on the type of incident involved, photos of the area may be helpful to show that it couldn’t have happened the way the employee described the incident. Document any other facts that you as the employer think are important. For example, does the worker have a long history of complaining about back pain, does the worker play a sport and was he/she recently injured while playing that sport? Is the worker disgruntled from a bad review? This type of information may be important but without the employer informing the carrier or the defense attorney, these facts may not get discovered. If there is a question about whether the incident happened then when reporting the incident to the State Accident Fund let them know. State Accident Fund has investigators in house that can assist you or call your defense counsel and ask about a particular situation.
ATTENTION CALENDAR YEAR POLICY HOLDERS: Premium renewals for calendar year policies were mailed the first week of November and payment was due December 1. If you have renewal questions, please contact John Long or Kirk Adair, the SAF Premium Auditors.
Inbox Office Safety
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A Safe Bet:3 Questions That Can Protect Your Employees
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Staff Update
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Reminders
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SAFE Mail, Volume 14, Issue 4 Fourth Quarter-2010
TERM OF THE QUARTER Lost Time When the treating physician authorizes a person to be out of work because of his/her injury. The person has to be out of work more than 7 days in order to be considered lost time.
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Safety on the Job
Office Safety Reprinted with Permission from the Workers Compensation Fund
It is often thought that workplace hazards don’t happen in the office. Unfortunately, this is not true. It is not unusual to hear of an office employee tripping over a computer cord or straining his/her back while moving a piece of office furniture. An office setting has its share of safety hazards, but many, can be eliminated. Office Traffic • Keep floors clean and free of spills such as beverages, melting sno w and rainwater. • Always walk, never run. • Keep aisles and hallways clear of clutter, debris and tripping hazards such as wastebaskets, electrical and computer cords, foot stools and open drawers. • Report torn or loose carpets, curled walk off mats, loose tile, uneven floor surfaces or any other condition that could lead to a slip, trip or fall to a supervisor immediately. File Cabinets • Close file, desk and cabinet drawers when not in use. • Put file cabinets and other storage cabinets far enough away from doors and aisles as to not interfere with exit routes or high traffic areas. • Place the heaviest files or loads in the lower drawers of file cabinets. • Open only one drawer at a time. • Use only the handle to open and close drawers to avoid finger injuries. Documents • Use caution when handling paper to avoid cuts. • Fully close staples. Use a staple remover to remove staples. Electrical Equipment • Locate electrical outlets so that cords do not cross aisles or passageways. • Use only properly grounded outlets and equipment. Avoid using extension cords.
SAFE Mail, Volume 14, Issue 4 Fourth Quarter-2010
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Replace damaged or worn cords immediately. • Unplug equipment before servicing or working on equipment. Machines and Equipment •Place guards on machines with exposed moving parts before operating. Do not operate a machine until you are properly trained. Do not override safety devices. When in doubt, get help. Use common sense when using paper cutters. Keep fingers away from knife and cutting edges. Keep knife in down position when not in use. Replace loose guards, knife locks and springs immediately.
Storage • Use a ladder, stool or portable stair for reaching high objects. Never use a chair, carton or another object not designed for the task. • Store heavy objects at ground level. • Cover or sheath knives and scrapers before storing. Use only for intended purpose. • Do not store flammable liquids and paint in an office area. If flammable or hazardous materials are needed for office machines, keep in limited quantities and store it according to m a n u f a c t u r e r ’ s recommendations.
Other Turn on lights before entering dark rooms or hallways. Report burnt out or inadequate lighting to your supervisor. • Do not lift beyond your capability. Get help with heavy or awkward loads. • Do not remain at your desk or workstation if overhead work is being performed. If your job requires you to enter manufacturing areas or a warehouse, wear the required personal protective equipment (e.g., hard hat, safety glasses, hearing protection). Do not enter a part of plant that is unfamiliar to you. Ask a plant supervisor to go with you. •
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Resources There are several OSHA regulations that can apply to office operations depending on the type of operation. Some of the most common are: • 29 CFR 1910 Subpart E - Means of Egress • 29 CFR 1910 Subpart H - Hazardous Materials • 29 CFR 1910 Subpart N - Materials Handling and Storage NOTICE: This guide may make reference to the Occupational Safety and Health Administration (OSHA) regulations; however the guide is not legal advice as to compliance with OSHA or other safety laws, codes or regulations. Compliance with OSHA and other safety laws codes or regulations, and maintaining a safe work environment for your employees remains your responsibility. SAF does not undertake to perform the duty of any person to provide for the health or safety of your employees. SAF does not warrant that your workplace is safe or healthful, or that it complies with any laws, regulations, codes or standards.
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Safety on the Job
A Safe Bet:3 Questions That Can Protect Your Employees By Carl and Deb Potter Many companies look at safety in terms of outcomes: their employees are either injury-free or injury-prone; their workplace has a greater or lesser number of incidents this year than last. Do you believe your workers’ actions or behaviors determine their safety? Does your company determine its safety level with a formula based on the number of personal workplace injuries or vehicular incidents your drivers had last year? While useful in some circumstances, these types of measurements are often referred to as “lagging indicators.” They reflect what has happened and in what quantities, but they really don’t tell the whole story of safety in your organization. There’s another—often better— way to measure and improve workplace safety. Consider how much you and your employees know about the way everyone works. This knowledge can help everyone to work safer and go home every day without injury. The next time your employees sustain an injury or have vehicle incidents—even when they only experience near-misses—take the time to think about what the event reveals about the level of safety knowledge in your company. You may be shocked at what you learn when you ask yourself and others involved these three questions: 1. What are the work procedures related to the task you were doing at the time of the incident? For example, if a worker was injured while using a hand tool, he may describe what he thought was the proper procedure for using the tool; when in fact no one may have trained him how to use the piece of equipment properly. In this case, you may learn that employees need training in the appropriate use of certain tools in order to avoid future incidents.
2. How did you learn to do the task you were doing when the incident occurred? Accident investigations often reveal that workers primarily learn to do their work from their peers through on-the-job training. In many industries, advances have been made over the years in technology and equipment, yet more seasoned workers may not be aware of these improvements. Sometimes these experienced, yet unaware, employees inadvertently pass along unsafe work practices to others who join their workgroup. As a result, new workers are continually trained in older—and probably less safe—work methods. If training and safety knowledge aren’t updated, dangerous situations can easily result. 3. What can we all learn from this so that no one else experiences a similar incident? Most people genuinely want to help their coworkers go home every day without injury, so you’ll probably get good ideas and valuable information when you ask this question. Share what you learn from these interviews throughout your company, especially with those who may face comparable circumstances, so everyone can avoid injury if a similar situation arises. In many cases, you’ll discover that good safety rules exist, and employees understand safe work procedures, but they feel they must rush their work so they take shortcuts that lead to injuries. When the employees involved in incidents or near-misses identify the underlying causes that result from being in a hurry, they can share the lessons they’ve learned for the benefit of all. Easy Does It Good communication is essential if the safety process is to be successful. Workers need to feel as if they’re involved in a process and making a contribution to the overall benefit of their co-
Question: We had an employee who hurt her knee in our cafeteria. She has a history of knee injuries. The injury occurred when she fell as she was carrying her lunch tray. She was wearing high heels, which is against company policy, and was distracted by waving and calling out to her friends. She was obviously not acting in a safe manner. Can we use the work-related exception §1904.5 (b)(2)(iv) for eating, drinking or preparing food or drink for personal consumption so that we will not have to record this case on our OSHA logs?
SAFE Mail, Volume 14, Issue 4 Fourth Quarter-2010
workers and the company, not as if they are snitches or risking punishment for divulging what really happened when the incident occurred. Ask these three questions in such a way that the involved workers feel comfortable about sharing information with you. If they feel as if what they offer will be used against them in any way, forget it! They’ll be unwilling to speak honestly— or possibly at all—and you’ll lose the opportunity to learn. On the flip side, if employees trust you and believe your questions are truly designed to uncover ways to make the workplace safer for everyone, then you’ll tap into a gold mine of good information. Then it’s vital to pass this information on to others throughout the company in a meaningful way. Knowledge Is Power! When it comes to safety, it really doesn’t matter who you know, it’s what you know. By asking these questions, you’ll gain knowledge that will allow you to provide your employees with an invaluable resource gleaned from the lessons learned by others. Share the information in safety meetings, employee discussions and pre-job briefings. Be sure to assimilate it into appropriate employee-training courses. When you do everything you can to ensure that employees know what they need to know in order to do their jobs safely and effectively, you’ll find that more injury-free workers will go home to their families every day. Carl Potter, CSP, CMC and Deb Potter, PhD, CMC have worked with hazardous industries for a combined total of more than 44 years. They work closely with many large corporations as speakers and consultants. They have authored several books including the best-seller “Who is Responsible for Safety?” “Simply Seamless Safety” and their latest book, “Zero! Responsible Safety Management by Design.” For more information, call 800.259.6209 or visit www.potterandassociates.com.
Answer: No. You cannot use the exception because she was not eating, drinking or preparing food or drink at the time of the injury. She was walking around in the on-site cafeteria. The rule of geographic presumption, §1904.5 (a) states: You must consider an injury or illness to be work-related if an event or exposure in the work environment either caused or contributed to the resulting condition or significantly aggravated a pre-existing injury or illness. Work-relatedness is presumed for injuries and illnesses resulting from events or overexposures occurring in the work environment, unless an exception §1904.5 (b)(2) specifically applies.South Carolina OSHA website.
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Reminders Following are some “insider tips” to help ensure smoother policy administration: •
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Get it in Writing: Take a written statement from the • injured employee immediately after a work-related injury or illness is reported. Have the employee document the reported cause, the scope of the injuries and the names of all witnesses. This prevents the • employee from later embellishing the injury or work exposures—or naming surprise witnesses. No Faxes: The State Accident Fund will NOT accept faxed bills and/or mileage statements.
No Out-of-Pocket: Policyholders, please discourage injured workers from paying out-of-pocket medical expenses. Contact Changes: When you have any staff changes that result in a change to your agency’s Worker’s Compensation contact person, please contact Rachel Cambre, rcambre@saf.sc.gov. Providing this updated information helps ensure that you receive all information in in appropriate and timely manner.
Contacts Staff Updates The State Accident Fund would like to welcome our newest Claims Technician, Anita Iari. If you need to contact your adjuster, or any SAF Staff, please visit our website, www.saf.sc.gov and click on Employee Directory for a complete listing of our staff email and phone numbers.
This newsletter is provided as a service to all SAF policyholders. If there is a topic you would like to see addressed, or if you would like to submit an article for possible publication, including information about an exemplary safety program that you are aware of, either in your workplace, or another policyholder’s workplace, please e-mail Rachel Cambre at rcambre@saf.sc.gov.
South Carolina State Accident Fund PO Box 102100 Columbia, SC 29221 Questions? Comments? Please contact Rachel E. Cambre, Editor Telephone (803) 896-5409 Fax : (803)612-2710 E-mail: rcambre@saf.sc.gov
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Workers’ Compensation Insurance
South Carolina State Accident Fund’s Quarterly Workers’ Compensation News and Information Resource SAFE Mail, Volume 14, Issue 4 Fourth Quarter-2010
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