How to Investigate Occupational Injury Claims

Occupational injury claims usually fall into one of two categories - benefits claims or negligence claims. Each requires investigation, but there are differences you must be aware of.

If your clients are using a third party administrator other than Anchor Claims you can do them a favor by asking them a few questions, or share this article with them, to see if they are getting proper service.

Benefit Claims

• Did the accident happen during the course and as part of the scope of the injured's employment?
• Was the accident reported in a timely manner?
• Is there a causal relationship between the accident and the injury?
• Is treatment related to the injury?
• Is there any reason to question the employee or employer about veracity of the details?
• Can the injured employee return to work?

Negligence Claims - all the questions for benefit claims apply, plus these:

* Did any machinery malfunction?
* Was the employer at fault?
* Is an outside party responsible (possible subrogation)?
* Was a safety program in place at the time of the accident?
* Was the injured employee properly trained?
* Did the employee violate any safety regulations?

Don't let your clients suffer headaches that are avoidable with good planning and professional claims administration. If you would like advice on how to handle a particular situation for a client, regardless of where you placed the business, please call Byron McBride at 214-295-1543, or email him at bmcbride@combindedgroup.com.