Posted May 15, 2024
Why Experience Matters When Handling Work Comp Claims

Anyone who handles Workers Compensation claims knows that sometimes things are not what they appear to be at first glance. The importance of a thorough claim investigation was highlighted in two recent claims handled by ICC.

Claim 1

ICC received notice of an alleged fight in which an employee of our insured was hit in the mouth and injured. The notice came via a letter of representation, seven months after the injury was alleged to have occurred. Our Claims Team immediately jumped into action by obtaining statements from those aware of the injured worker and alleged fight. The normal investigation guidelines were met even though the claim was reported to us seven months after the incident.

Once we had all the documents required to make a determination regarding compensability, we found reason to pause. Things did not add up between the statements and medical records. We decided to refer the file to our defense attorney in that jurisdiction, who agreed that there was reason to dispute the claim.

The injured worker’s attorney wanted to wrap it up quickly and provided a very high demand. Armed with the information from the investigation, our defense attorney was able to settle the claim on a disputed basis for less than half of the original demand.

Claim 2

Another recent claim provides an example of how thorough investigations can uncover new information, leading to a better result for our insured. A claim was reported for a burn to an employee’s hand. The recorded statement from the injured worker claimed that when he was walking a pot of hot water to the sink, the water splashed out and burned his hand.

The insured provided us with a different record of the incident. They claimed that a couple of employees, who were goofing around, dared another employee to put his hand in a pot of boiling water. However, we had already obtained a witness statement that aligned with the injured worker’s statement.

Because of the conflicting statements, the only way we could truly know what happened was to have a recording of the incident. We went back to the insured and asked if they had any video cameras in their kitchen. Luckily, they had exactly what was needed to back up their statement.

The video footage clearly showed two employees talking, and the injured worker voluntarily putting his hand into the pot of hot water. With this evidence, we were able to go back to the injured worker and the witness, who both admitted to what really happened. The claim was managed accordingly.

A working surveillance camera is your most reliable witness.

For more information about insuring your business with ICC, contact an agent in your area through our Find an Agent search.