Who Does What?

Everyone has different roles and responsibilities in managing a Workers Compensation claim. When all parties know and own their responsibilities, injured employees will recover faster, resulting in reduced costs for all.

Employee Role & Responsibilities:

  • Report the accident immediately
  • Keep their supervisor up to date
  • Attend all scheduled medical appointments
  • Bring the report of workability to their supervisor after each doctor visit
  • Advise their supervisor of any issues
  • Stay within restrictions at work and home

It is imperative the accident be reported immediately so the injured worker can receive immediate medical attention and begin the healing process. It is also important that management know of any unsafe conditions immediately so they can be addressed and prevent further injury.

By keeping their supervisor up to date on how they are doing or when medical appointments are scheduled, the supervisor can do a better job in ensuring the injured worker will not re-injure or aggravate their condition while on restrictions. The injured worker needs to make sure and attend all medical appointments and follow recommendations from their doctor so they do not impede their recovery. They need to let their supervisor know immediately if they have any issues with their job, restrictions, claims adjuster, etc. If they receive any bills, they need to make sure and bring to the supervisor so the supervisor can have HR forward to the claims adjuster.

Probably the most important responsibility the injured worker has is staying within their restrictions at work and at home. The restrictions do not end once the injured worker clocks out. Staying in the restrictions will result in a quicker and safer recovery.

Supervisor Role & Responsibilities:

  • Complete supervisor accident investigation
  • Set expectations of injured worker and Return to Work
  • Follow up with the injured worker
  • Follow up with HR/Risk Management
  • Ensure injured worker performs work within restrictions
  • Elevate any issues
  • Document, document, document
  • Follow medical care

Some say the supervisor has the most critical role in whether or not a workers compensation claim will go smoothly or not. They are closest to the injured worker and understand the requirements of the job. Conducting the accident investigation immediately is a must. It is important to document how the injury occurred, why it occurred and what can/will be done to prevent it from occurring again. The investigation also helps to determine what injuries the injured worker sustained to what body parts. The claims adjuster relies heavily on this investigation.

After the injured worker's immediate medical needs have been addressed, the supervisor should reassure the injured worker that they will review the ROWA from the doctor and return the injured worker back to work ASAP. By setting the expectations that the injured worker is expected to return to work even if they are given restrictions by the doctor, we fend off the onset of disability syndrome.

The supervisor needs to check in with the injured worker daily and see how they are doing. They need to make sure the injured worker is performing their duties following the restrictions and that the injured worker knows to advise them if anyone asks them to work outside of the restrictions. The supervisor needs to elevate any issues to HR.

HR Department Role & Responsibilities

  • Report the claim immediately
  • Provide payroll information to the claims adjuster
  • Provide job description to the claims adjuster
  • Assist with return to work
  • Maintain a separate workers compensation file
  • Communicate with injured worker, supervisor and claims adjuster

The supervisor will rely on HR to assist them in managing the injured worker and be available to assist as needed. HR oversees the claim for the employer and helps to address any issues and concerns.

Doctors Responsibilities

  • Provide initial diagnosis and prognosis
  • Provide restrictions
  • Provide timely records and bills
  • Hold injured worker accountable on following recommendations
  • Cooperate with all parties involved
  • Provide reasoning for referrals or diagnostic testing
  • Follow Minnesota statutes governing workers compensation

It is important for the doctors to understand the job duties of the injured worker and be familiar with your return to work program. Occupational medicine doctors are well versed in the general knowledge of worksite operations and are qualified to determine an injured workers physical and emotional fitness for work. The doctor should provide accurate diagnosis and appropriate treatment following the MN WC Act treatment parameters. The doctor should also provide prompt and accurate identification of non-work related complaints so they can be addressed immediately and deter litigation.

Claims Adjuster Role & Responsibilities:

  • Investigate the claim
  • 3 Point Contact (with Employer, Doctor, Employee)
  • Identify need for additional services
  • Provide access to PPO networks
  • Communicate with injured worker and employer
  • Follow medical care

The claims adjuster should contact the employer, healthcare provider and injured worker within 24 hours of assignment of the workers compensation claim. They normally contact the employer first to understand how the accident happened, and to discuss red flags and return to work. Second contact is the healthcare provider to obtain diagnosis and treatment plan as well as provide the provider with their information so the records and bills will be submitted and paid timely. Finally, the claims adjuster contacts the injured worker to explain the benefits, review how the accident occurred, and obtain additional information that will assist them in completing their investigation. The adjuster will identify the need for additional services such as nurse case managers, QRCs, defense attorneys, IMEs, etc.

Most importantly, the claims adjuster should be in constant communication with the injured worker and employer so everyone is on the same page. Issues always arise when there is no or poor communication. The claims adjuster cannot follow the medical care if they are not communicating.

Nurse Case Manager Role & Responsibilities

  • Assist with medical case management of the claim
  • Attend doctor appointments, as needed
  • Follow up with doctor, injured worker and HR/Risk Management
  • Conduct Job Analysis
  • Assist with Return to Work

The nurse case manager should be a neutral party in the claim. Their job is to assist the injured worker in recovering and manage the medical portion of the claim. 

QRC (Qualified Rehab Consultant) Role & Responsibilities

  • Perform the rehabilitation consult
  • Write the rehabilitation plan
  • Follow up with doctor, injured worker and HR/Risk Management
  • Conduct Job Analysis
  • Assist with Return to Work
  • Assist with vocational testing
  • Assist with job search
  • Assist with job placement

The QRC should be a neutral party in the claim as they assist in returning the injured worker to work. There are specific rules for QRCs according to Minnesota statutes governing workers compensation. Though QRC is unique to Minnesota, other states use similar roles for vocational benefits.

Defense Attorney Role & Responsibilities

  • Assist with determining compensability
  • Provide legal opinions based on case law and Minnesota state statutes governing workers compensation
  • Defend employer if injured worker sues employer
  • Attend all hearings
  • Provide exposure analysis, options and recommendations
  • Coordinate and manage the discovery process

Workers Compensation defense attorneys represent and defend the employer in litigation. They should provide defense to minimize exposure to workers compensation claims within the full scope of the employee-employer relationship. They should provide an analysis of the exposure of the claim with the options that are available and their recommendations

Minnesota Comp Advisor Roles and Responsibilities

Employee injuries occur sporadically, and each claim is very different from the next. It's likely HR and safety managers, as experienced as they are, have little to no training or experience in managing workplace injuries. Minnesota Comp Advisor provides additional assistance and expertise to the employer's management team to help injured employees recover at work, and lower overall costs for the employer.

  • HR Expert - Assist employer's HR department in managing claims and dealing with complex work comp situations.
  • Claims Management Expert - Monitor claims from filing through close, communicates with adjusters, carriers, doctors, nurses, employee and employer to get employees back to work quickly and safely, and works with adjuster to lower or resolve open claims.
  • Safety and Fraud Expert - Assist supervisor with accident investigation, look into suspected work comp fraud, and assist with correcting unsafe conditions and improving workplace safety.

Minnesota Comp Advisor's roles and responsibilities extend beyond claims management to preventing injuries, and lowering the cost of claims when injuries occur, among other responsibilities.