An employer must provide statutory benefits to employees who have an accident and sustain an injury which arises out of and in the course of employment. It follows that an employer must be notified of the accident and any resulting injury, within a reasonable time, so that it has an opportunity to determine if the claimant is entitled to benefits, and the extent of those benefits, before it can be held responsible for compliance.
Notice to the Employer.
The employee must provide notice to the employer within 30 days after the accident causing injury or death to the employee. WCL §18. The notice should be in writing and provide:
The name and address of the employee;
The time of the accident causing the injury;
The place of the accident;
The nature of the injury sustained by the employee;
The cause of the injury; and
The signature of the employee, or a person on behalf of the injured employee.
Manner of transmission.
If the notice is sent to the employer via mail, the notice must be sent via registered mail to the last known place of business. WCL § 18.
This post provides a general overview of how traumatic, specific accident claims are generally handled.
At the time of the accident:
First, the worker gets medical treatment and notifies her supervisor about the accident and how it occurred.
The employee notifies the employer of the accident in writing, as soon as possible, but within 30 days. The Board may excuse the lack of notice if notice could not be given (for example: the claimant was taken to the hospital and could not inform her employer), the employer had knowledge, or if the employer is not harmed by lack of notice. WCL § 18.
Timeline of the “Typical” case: Admitted Traumatic Accident with Lost Time.
Initial investigation to confirm loss.
If there is medical and lost time, begin benefits.
File FROI-00 (Electronic Data Interchange, “EDI”).
File update EDI documents as the case progresses.
The Board’s initiative to enforce EDI (“eClaims”).
Beginning in 2013, the Board has begun an increased tempo of “monitoring and compliance” initiatives intended to enforce the eClaims guidelines and generate more penalty income for the State. The Board has now established a “Compliance Unit” intended to do the following:
monitor performance standards for timely submission of First Report of Injury,
confirm timely first payment of indemnity benefits,
check for timely submission of Subsequent Report of Injury showing first payment,
monitor timely submission of Controversy; and
track the Percentage of Claims Controverted (how many cases is the carrier denying?).