Hospitality Workers Compensation Fundamentals
When a hotel employee is injured on the job and a claim is filed, the workers’ compensation system can often feel like “The Bermuda Triangle”: Employees enter and it’s anyone’s guess when, or even if, they’ll come back again. Although the system can be complicated, and some employees seem destined to be off work indefinitely, there are a few simple steps you can take as a hotel owner or general manager to help ensure that, if possible, your injured hotel workers will progress through the treatment process and return to work.
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hen a hotel employee is injured on the job and a claim is filed, the workers’ compensation system can often feel like “The Bermuda Triangle.” Employees enter and it’s anyone’s guess when, or even if, they’ll come back again. Although the system can be complicated, and some employees seem destined to be off work indefinitely, there are a few simple steps you can take as a hotel owner or general manager to help ensure that, if possible, your injured hotel workers will progress through the treatment process and return to work. Before walking through these steps, I think it’s important to acknowledge that some employees who file workers’ compensation claims are not legitimately injured on the job and do not want to return to work under any circumstances. They may seek to litigate and intentionally elongate their claim in an attempt to extract as much money as possible from the carrier and, indirectly, from your hotel. Regardless of your belief in a claim or claimant’s credulity, applying a consistent, company-wide framework for responding to an injury is the best approach. It will help you properly handle the claims of your hotel employees who are legitimately
injured on the job and who have the desire, and physical ability, to return to full time duties. Such an approach will also allow you to limit your liability for malingering employees. Step 1: Train management and supervisory staff to properly handle employee injuries when they occur Training your management and supervisory staff to properly handle employee injuries when they occur is the first step in the correct management of a workers’ compensation claim. This includes: • Making sure the injured employee receives proper medical attention, either onsite from an EMT or at a designated clinic within your workers’ compensation carrier’s Medical Provider Network (MPN). We do not recommend using hotel staff or vehicles to transport the employee on their initial visit to the clinic or any follow-up appointments. Reporting the claim to the carrier immediately. Completing any company or state-required paperwork after the injury occurs.
• •
Multiple studies have shown that delays in reporting
claims to the carrier are directly related to the increase of overall costs for the claim and the potential for litigation. At an absolute minimum, every GM or supervisory staff member responsible for reporting injuries should know the following information: • • • Location of the designated MPN clinic for treating injured employees. Phone-in claim reporting number for your workers’ compensation carrier. How to properly document the claim.
Once the claim has been reported to the carrier, an adjuster will be assigned who will be able to guide your reporting staff member through any forms that need to be completed for the claim to be properly processed. Step 2: Let the injured employee know you care about their well-being. Letting an injured employee know that you genuinely care about their well-being can have a positive effect on the outcome of a workers’ compensation claim. Hoteliers often respond to reported guest injuries that occur on their premises with a level of accommodation, belief, and concern that epitomizes hospitality. Handle employee injuries in the same way. Something as simple as sending flowers and a get-wellsoon card to the injured employee’s home, along with a phone call from a concerned member of your management team (preferably speaking the employee’s primary language), will send an important message to your injured employee: You matter and we want you back! This is a step that requires absolutely no knowledge of the workers’ compensation system and may pay huge dividends by creating a work environment that employees want to return to. Step 3: Engage Injured Employees in the Interactive Process. Most hotels have a “return to work” or “modified duty” program for accommodating injured workers who are able to perform alternate job functions as they continue to recover and transition back to full-time, unrestricted duty. But what happens when an employee returns from the medical clinic with restrictions that don’t fit a modified duty position you have available? Hoteliers who find themselves in this situation need to engage the injured employee in the “Interactive
Process.” This is not an option - it’s the law! The Interactive Process is a good faith effort on the part of the employer to discuss with the injured employee, their injuries and restrictions, as they relate to available modified duty positions at the hotel. Each interaction should be documented, and an impartial translator should be present if English is not the employee’s primary language. The spirit of these meetings is to come to a group decision, with the employee’s input, regarding their current capability of performing the modified duty positions available. There are many facets regarding your attempts at accommodation that cannot be fully discussed in this article. For a comprehensive analysis of the interactive process, please follow the link below: https://www.dir.ca.gov/chswc/Reports/2010/HandbookRTW_2010.pdf Step 4: Communicate with the injured employee and the adjuster during rehabilitation and closely monitor follow-up treatment visits. Proper initial claim reporting and expressing your concern to an injured employee for their well-being, may not mean much if you do not closely monitor and communicate with them throughout their treatment process. Diligently oversee follow-up visits to the primary treating physician. Know when their appointments are and follow up after every doctor’s visit to verify what changes, if any, were made to the employee’s status. This will help to ensure that a claim is properly progressing towards closure. Employees who routinely miss their follow-up appointments, or who won’t return your phone calls, should be monitored closely as these are red flags for potential litigation. Working with the carrier-assigned adjuster is also a critical step in the treatment process. This includes forwarding the adjuster the status slips you receive from the clinics, notifying the adjuster immediately when lost time begins, and letting the adjuster know when employees come back to work. Following these four simple steps when handling hotel workers’ compensation claims is not a failsafe for every situation, but it does give an effective framework to help return legitimately injured employees back to their jobs. Proper claims management can also help lower overall claims costs and may even prevent a lawsuit. All of this can pay dividends, when it results in lower insurance premiums.
Brad Durbin is a Hospitality Insurance Specialist with Petra Risk Solutions, “America’s largest independent insurance brokerage devoted exclusively to the hospitality marketplace.” 800.466.8951 PetraRiskSolutions.com
hen a hotel employee is injured on the job and a claim is filed, the workers’ compensation system can often feel like “The Bermuda Triangle.” Employees enter and it’s anyone’s guess when, or even if, they’ll come back again. Although the system can be complicated, and some employees seem destined to be off work indefinitely, there are a few simple steps you can take as a hotel owner or general manager to help ensure that, if possible, your injured hotel workers will progress through the treatment process and return to work. Before walking through these steps, I think it’s important to acknowledge that some employees who file workers’ compensation claims are not legitimately injured on the job and do not want to return to work under any circumstances. They may seek to litigate and intentionally elongate their claim in an attempt to extract as much money as possible from the carrier and, indirectly, from your hotel. Regardless of your belief in a claim or claimant’s credulity, applying a consistent, company-wide framework for responding to an injury is the best approach. It will help you properly handle the claims of your hotel employees who are legitimately
injured on the job and who have the desire, and physical ability, to return to full time duties. Such an approach will also allow you to limit your liability for malingering employees. Step 1: Train management and supervisory staff to properly handle employee injuries when they occur Training your management and supervisory staff to properly handle employee injuries when they occur is the first step in the correct management of a workers’ compensation claim. This includes: • Making sure the injured employee receives proper medical attention, either onsite from an EMT or at a designated clinic within your workers’ compensation carrier’s Medical Provider Network (MPN). We do not recommend using hotel staff or vehicles to transport the employee on their initial visit to the clinic or any follow-up appointments. Reporting the claim to the carrier immediately. Completing any company or state-required paperwork after the injury occurs.
• •
Multiple studies have shown that delays in reporting
claims to the carrier are directly related to the increase of overall costs for the claim and the potential for litigation. At an absolute minimum, every GM or supervisory staff member responsible for reporting injuries should know the following information: • • • Location of the designated MPN clinic for treating injured employees. Phone-in claim reporting number for your workers’ compensation carrier. How to properly document the claim.
Once the claim has been reported to the carrier, an adjuster will be assigned who will be able to guide your reporting staff member through any forms that need to be completed for the claim to be properly processed. Step 2: Let the injured employee know you care about their well-being. Letting an injured employee know that you genuinely care about their well-being can have a positive effect on the outcome of a workers’ compensation claim. Hoteliers often respond to reported guest injuries that occur on their premises with a level of accommodation, belief, and concern that epitomizes hospitality. Handle employee injuries in the same way. Something as simple as sending flowers and a get-wellsoon card to the injured employee’s home, along with a phone call from a concerned member of your management team (preferably speaking the employee’s primary language), will send an important message to your injured employee: You matter and we want you back! This is a step that requires absolutely no knowledge of the workers’ compensation system and may pay huge dividends by creating a work environment that employees want to return to. Step 3: Engage Injured Employees in the Interactive Process. Most hotels have a “return to work” or “modified duty” program for accommodating injured workers who are able to perform alternate job functions as they continue to recover and transition back to full-time, unrestricted duty. But what happens when an employee returns from the medical clinic with restrictions that don’t fit a modified duty position you have available? Hoteliers who find themselves in this situation need to engage the injured employee in the “Interactive
Process.” This is not an option - it’s the law! The Interactive Process is a good faith effort on the part of the employer to discuss with the injured employee, their injuries and restrictions, as they relate to available modified duty positions at the hotel. Each interaction should be documented, and an impartial translator should be present if English is not the employee’s primary language. The spirit of these meetings is to come to a group decision, with the employee’s input, regarding their current capability of performing the modified duty positions available. There are many facets regarding your attempts at accommodation that cannot be fully discussed in this article. For a comprehensive analysis of the interactive process, please follow the link below: https://www.dir.ca.gov/chswc/Reports/2010/HandbookRTW_2010.pdf Step 4: Communicate with the injured employee and the adjuster during rehabilitation and closely monitor follow-up treatment visits. Proper initial claim reporting and expressing your concern to an injured employee for their well-being, may not mean much if you do not closely monitor and communicate with them throughout their treatment process. Diligently oversee follow-up visits to the primary treating physician. Know when their appointments are and follow up after every doctor’s visit to verify what changes, if any, were made to the employee’s status. This will help to ensure that a claim is properly progressing towards closure. Employees who routinely miss their follow-up appointments, or who won’t return your phone calls, should be monitored closely as these are red flags for potential litigation. Working with the carrier-assigned adjuster is also a critical step in the treatment process. This includes forwarding the adjuster the status slips you receive from the clinics, notifying the adjuster immediately when lost time begins, and letting the adjuster know when employees come back to work. Following these four simple steps when handling hotel workers’ compensation claims is not a failsafe for every situation, but it does give an effective framework to help return legitimately injured employees back to their jobs. Proper claims management can also help lower overall claims costs and may even prevent a lawsuit. All of this can pay dividends, when it results in lower insurance premiums.
Brad Durbin is a Hospitality Insurance Specialist with Petra Risk Solutions, “America’s largest independent insurance brokerage devoted exclusively to the hospitality marketplace.” 800.466.8951 PetraRiskSolutions.com
