Michael B. Stack
Members of the claims management team and other interested stakeholders in a workers’ compensation program need to be proactive when it comes returning an injured employee back to work. This includes being ethical and hardworking when it comes to vocational rehabilitation matters. This is especially the case when it comes to overcoming common barriers in the RTW and rehabilitation process. Failure to do so can result in increased workers’ compensation costs and other added expenses.
Who is Responsible
The employer is the most important and impactful party in return to work. The best practice is for the employer to develop the position of a “RTW Coordinator.” This should be a person who is knowledgeable in human resource matters, state and federal disability and discrimination laws, and accessible to the entire workforce. The RTW Coordinator should also be responsible for all interactions with the injured worker on behalf of the employer and maintain documentation related to a workers’ compensation claim.
Responsibilities of the Employer: This party is responsible for reporting the work injury and helping with the investigation. The employer should take action in letting the employee know their rights, which is often required under a state workers’ compensation law. They are also responsible for identifying available light-duty work opportunities and monitor the employee’s recovery.
Responsibilities of the Insurer: Coordinate with the employer on all work injury matters and pay for all workers’ compensation benefits the injured employee is entitled to under the law. The insurer can also make recommendations on light duty job opportunities and provide education to their insured.
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October 14, 2015 by Michael B. Stack
Imagine the following scenario when handling a workers’ compensation claim:
John Doe is a construction worker who shows up for work on Monday morning appearing to being “a little off his game.” Shortly after starting work he falls from some scaffolding and suffers a severe work injury. Following the accident, he was taken to a hospital. Post-injury blood testing is performed and it is determined his blood alcohol level is three times the legal limit.
Sounds like an easy case for maintaining a denial of primary liability related to the work injury, right?
Sadly, this is not the case.
What is the “Intoxication Defense?”
Under most workers’ compensation laws, employers and insurers can successfully deny primary liability related to injuries sustained when an employee is “intoxicated.” This defense is not limited to being impacted by alcohol. It can also include intoxication from street drugs or other controlled substances.
Questions as to Legal Causation
Notwithstanding the obvious impairment in the above situation, the ultimate question for the courts is typically one of the legal or proximate cause of the work injury. One example of this issue came into play in Kowalik v. Martinson Construction, July 8, 2004, MN WCCA.
Continue reading 5 Shots Of Tequila Does Not Always Equal Denied Work Comp Claim
This is from a Canadian perspective, but we think you’ll find the information pertinent to almost any work situation.
One of the biggest barriers to improving health and safety is the belief that work-related injury, disease or death “can’t happen here”. I’m not saying injuries are an inevitable part of work. What I am saying is that believing work-related injuries are not possible actually makes it more likely they will occur.
A teacher commented to me that workplace health and safety really wasn’t an issue where he worked—a high school. The only health and safety issues he could identify involved the occasional issue in one of the industrial education or foods classes. “Schools are safe places for students and staff. Work-related injuries can’t happen here.”
I agreed that schools are generally safe for students and teachers but hazards and risks of injury are present in every workplace in every sector—including education. I listed Sandyhook, Columbine, Virginia Tech, and École Polytechnique as high profile examples of a very real risk of violence in the education sector that has lead to the injury and death of students and workers. These tragedies tell us about very real risks—risks that have been identified and have led to most schools to perform a risk assessment and develop new procedures.
He conceded that his school now practiced procedures in the case of an intrusion but he put the risk of such an incident right up there with earthquakes and fires: possible but not probable. “These are rare events—terrible but rare. Work-related injuries to teachers, teaching assistants, administrators and other staff in educational settings just don’t happen in day to day work…do they?”