Accident Investigation for Workers’ Compensation Claims对工伤事故调查索赔.ppt

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1、Accident Investigation,Name,Job TitlePhone number E-mail address,Purpose of Presentation,Overview of workers compensation accident investigation processValue of investigation following an accident(whether compensable or not)Elements of Accident Investigations,Goals&Objectives,Increase your knowledge

2、 of the workers compensation accident investigation processIdentify methods of investigationDetermine the causes of accidentsIdentify tools used in the investigation processFine tune your accident investigation skills,Employee Must Provide“Notice”,Why:To notify the employer that the employee had an

3、injury at work so that the incident can be investigated.,Employee Notice of an Accident,(Insert your agencys reporting policy and key process steps)Immediate written notice requiredEnables prompt investigation of factsAllows employer to provide necessary medical attentionIf the employer does not inv

4、estigate,may not be able to prove the facts.,Best Practices,Injured worker should immediately notify his/her supervisorThe supervisor should investigate or notify whoever is responsible for agency investigation immediately!Submit claim within 5 days,Investigate to Determine Greater Risk,Injury arise

5、s from a risk not shared by the general publicThere is a causal connection between the injury and the employmentEmployee exposed to a particular dangerThe risk is peculiar to the employment,How Can You Help?,On-Site Investigators Role In Workers Compensation Claims,Why Investigate WC Claims?,Executi

6、ve Order 52(99)Needed to assist claims staffDetermine causeDocument sceneDocument what people said and sawPrevent future accidents,Documentation,Document information you hearDocument the scene through photographs,sketches,written descriptions,video recordingsDocument evidence of non-work injuryInves

7、tigate facts that contradict injured workers versionInvestigate personnel or disciplinary problems that impact the claim situation,Documentation,Insert information here on your agencys policy Do you have internal forms?Where does the investigator get the forms?Who does the documentation go to for fo

8、rwarding to the claims staff?What timeframes are in place for completing the investigation?Any timeframes for follow-up for correction of hazards?,What Else?,Gather contact information on witnesses&supervisorsObtain witness and supervisor names,phone numbers,best time to contactProvide this informat

9、ion to agency personnel to forward to claims staff,Photographs,Why are photographs so important to OWC?Support factsDocument sceneBecome the“eyes”forpeople not in the fieldMay be required if litigated,Exposure to Bloodor Other Body Fluid,Document:Who is the sourceWas there any possible transmission

10、of diseaseContact with cuts,scrapesContact with eyes,nose,mouth,Exposure to Bloodor Other Body Fluid,Insert your agencys policy on how to handle exposure incidents here.,Claims Staff Role,Claims staff receives information from agencyWill investigate the Who,What,Where,When and How questionsMay call

11、with additional questions or to obtain the injured workers or witnesss statementClaims staff determines compensability,32.1-45.1 Code of VirginiaDeemed Consent,Covers health care workers,law-enforcement officers and 1st respondersSource can be required to give blood sample for testingEmployee or the

12、ir agency has the right to access the test results,Investigations,What is an“Accident”?,Any unplanned event that results in personal injury or in property damage.Not intendedNot reasonably anticipated,So What is a“Cause”?,It is the reason for an action or condition;something that brings about an eff

13、ect or result.(Websters dictionary),Accident Investigations,The failure of people,equipment,supplies or surroundings to behave or react as expected causes most accidents.Accident investigations determine how and why these failures occur.Conduct with prevention in mind NOT to place blame!,Why Should

14、the Agency Investigate?,Assist workers comp claims processTo be the“eyes and ears”in the fieldTo gather facts on-siteTo preserve evidence that may be lost over timeTo determine cause of the accidentTo identify ways to prevent accidents from recurring,Best Practices,Make sure the injured worker is ta

15、ken care of firstSecure the scene to preserve the integrity of the sceneGather all necessary equipment to begin investigation,What is the Investigators Role?,Do:Go to the accident siteInvestigate and document the causeDocument supervisor and witnessesPreserve the evidenceDont:Speculate on coverageCo

16、nduct formal interviewsGive advice,Guidelines for Investigators,Agency investigator should:Survey,secure and document the siteIdentify the causeLook for contributory hazards Report conclusions and recommendations,Investigative Techniques,INVESTIGATE IMMEDIATELY!Dont assume anythingObtain all possibl

17、e factsPreserve the evidenceTake photographs of the siteTake measurements and diagram if necessary,Dont Make Assumptions,Gather the factsWhat did the injured worker say happened?What did witnesses see?What did the injured worker tell witnesses?Talk to the supervisor,What Do You Ask?,What did the inj

18、ured worker tell you?Where and when did the accident occur?Were there any witnesses?How was the employee injured?Was training provided for this task?Were the safety rules followed?,Additional Questions for the Supervisor,Was the employee doing an assigned task?Had the employee been trained on the ta

19、sk?Had the employee ever done this task before?How often is this task performed?,Preserve the Evidence,Before you preserve it,lets define it:Evidence is data,which helps to prove the eventNext,decide what evidence is importantImmediate photographs are criticalThe site could change the next day and e

20、vidence would be lost,What Do You Photograph or Videotape?,Sites of accidents,including:DefectsHazardsUnusual ConditionsConditions that differ from what the employee describesAreas or furniture in need of maintenanceHousekeeping issues,What to Look For?,Liquid substances or objects on a floorWorn tr

21、eadsSlippery floor(heavy wax)Loose rungs on a ladderFrayed or torn carpetType of shoesAnything being carriedAnything out of the ordinary,Weather,Sunny and clear?Rainy?Foggy?Icy?TemperatureColdHot,Housekeeping,Clear,unobstructed walkwaysPassageways and aisles free of protruding nails,loose boardsDebr

22、isUnwanted ClutterBoxes in aislesObstacles/barriers,Environmental,May include the following elements:StairsLadders(portable,extension,etc.)Machinery,i.e.power sawsAny room,i.e.training,sleeping quartersWallsFurniture,such as tables or chairsVehiclesSidewalk cracks(take measurements),Whats wrong with

23、 this picture?“I was working at my desk and all of a sudden I noticed pain in my left wrist”,Whats wrong with this picture?“Ive fallen(and I cant get up)”,Whats wrong with this picture?,(Agency Name)Most Common Accidents,Struck by/strike againstMaterial HandlingSlips,Trips,Falls,Need Assistance?,Were here to help!,Questions?,Remember:Think“out of the box”Trust your instinctsUse common sense,