When it comes to workers’ compensation, it’s important to report every claim right away, even if the claim seems downright absurd. Those are the claims that will likely take more time to settle. Why? Some claims, like a finger caught in a machine, are obviously related to the activities of work. It’s the more questionable claims that may require an in-depth investigation first.
Sometimes, these questionable or “strange” claims can be delayed for weeks or even months while the employer tries to determine if it should or shouldn’t be reported as a workers’ compensation claim and important investigative material can be lost. It’s always best to report the claim right away and let the adjuster begin their investigation.
So what would qualify as a “strange” claim? I have seen many! For example, I recently investigated the claim of a cleaning woman whose job duties included cleaning out a parrot cage. Was she attacked by the parrot? No, the woman explained her job required her to place the parrot on her pinky finger each day as she cleaned out the parrot’s cage. Eventually, her finger became sore and disfigured – there’s the claim. Another involved a waitress carrying a stack of menus. She sneezed causing one of the menus to fly up and cut her eye. Perhaps one of the most unsettling claims in my mind was the claim for a receptionist simply stating “animal bite.” It turned out the woman was sitting at her desk when a mouse ran up her pants leg and bit her. Personally, it made me consider placing rubber bands around the ends of my pant legs as I can’t think of anything more disgusting than a mouse. We often receive claims of employees involved in horseplay or even altercations at work. The reason behind the conflict is just as important as the injuries themselves. Were the workers fighting over a specific element of their job, or was it a fight over last night’s basketball game?
No matter how far-fetched or strange a claim may seem, all claims should be reported right away. The statutes in each state vary. Some statutes require acceptance or denial of a claim in as little as 14 days after the date of loss. Late reporting can lead to a loss of information, witnesses who no longer work for the insured, or the inability to medically manage a claim from the very beginning. Remember that reporting a claim and completing a first report of injury is not an admission of liability. As an insurance company, if we are notified immediately, we can complete our investigation, document the file, and begin to promptly assist the injured worker with obtaining the appropriate medical care and direction. If the claim is compensable, we can begin to promptly assist the injured worker and control costs. If it is determined to be unrelated to work, a timely denial will be filed with the state, but we will know we had all the facts and information, and the worker was cared for appropriately.
Moral of the story, don’t wait to file a workers’ comp claim, regardless of the injury. Do you have any “strange” workers’ compensation claims stories? I’d love to hear them!
Leave a Reply