The First Hour After a Workplace Injury Sets the Claim Cost

When workers' comp costs climb, many employers point to fraud. System abuse exists, but it is not the main driver. The bigger problem is that most employers have no plan for the first hour after an injury.

You research vendors, negotiate prices and spend weeks picking a copier. Then someone gets hurt and the response is made up on the spot. That is the most expensive mistake in your program.

The default path is the expensive path

Most injured employees have never been hurt on the job before. They are uncertain, and they will do what they are told. Without a plan, the default instructions are predictable.

The first is "Go to the emergency room." The ER is built for life-threatening cases, not for managing a work injury. The second is "See your family doctor." A family doctor treats general health, and the advice is often to take a few days off and rest. That sounds kind. It can lead to deconditioning, and it can turn a minor strain into a long absence.

The longer someone stays out, the less likely they are to come back to your company. Then you pay twice, once for the claim and again to hire and train a replacement.

To be clear, a true emergency belongs in the ER. Call 911 first, plan second. This post is about the injuries that are not life-threatening, which are most of them.

The system is the problem, not the employee

When a claim goes bad, the cause is usually an undefined process. Not a dishonest worker. If you want to control the outcome, control the process from the first minute.

The fix is simple. Before anyone is hurt, pick a local clinic that specializes in occupational health. These clinics start from a different idea. Recovery is active, and long time away from work is a health risk in itself. Their goal is good care that leads to a safe and timely return to the job.

What the data says

A study of Louisiana lost-time claims, published in 2005, compared claims handled by a small network of occupational health physicians with claims handled by other physicians. The median cost was $3,015 with the network and $5,793 without. The median time off work was 34 days with the network and 58 days without. The data is older and covers a single year, but it points the way. The study is listed in this research database.

The reason it matters is lost time. NCCI research has found lost-time claims cost about 40 times what medical-only claims cost, as PropertyCasualty360 reported on an earlier NCCI study. Cut lost days and you cut cost.

In my experience, roughly 20% of your claims drive 80% of your cost. The best way to shrink that 20% is to manage the medical care from the first minute.

Build your plan before you need it

Four steps get you there. First, find a reputable occupational health clinic near your workplace. Second, meet the physicians and make sure their approach matches yours. Third, make that clinic your designated provider for work injuries. Fourth, train your supervisors so the response is immediate, consistent and professional.

One boundary. Some states let the employee choose the doctor, and some let the employer direct care. Check your state's rule before you name a clinic. Your agent can tell you where you stand.

Supervisors carry most of this. We look at what happens when they are trained in our post on stalled recovery. For how this connects to your premium, see why claim frequency drives your mod.

First-hour FAQ

Should an injured employee ever go to the ER?

Yes, for a true emergency. Call 911 for anything life-threatening. The plan covers the many injuries that are not.

Can I require my employee to use my clinic?

It depends on your state. Some states allow employer-directed care, and others give the choice to the employee. Ask your agent.

What does this have to do with my mod?

Lost-time claims weigh heavily in your experience mod. Keeping an injury medical-only and getting someone back to work sooner lowers the impact. The injury prevention module covers how.

Adapted from an earlier post at the Institute of WorkComp Professionals: How You Manage an Injury's First Hour Determines Its Final Cost.