When investigating work-related injuries,
the first rule is "Do No Harm"

Thilman Filippini guidelines for HR managers and risk officers

By PJ McNamara, Vice President
Thilman Filippini Claims Management Division

The job requirements for a director of Human Resources are many and challenging — but don't usually include a degree from detective school. Nonetheless, HR managers increasingly are being asked to conduct or coordinate professional internal investigations of incidents and injuries leading to workers compensation claims.

This can be a daunting test of your "people skills."

Often you'll face conflicting versions of what happened, when, how and why. The investigation itself can on rare occasion become contentious — and even a source of potential liability — if not handled properly.

The good news is this isn't "CSI: New York." While you may use forensic guidelines such as preserving the accident scene and collecting evidence, there are no "suspects." Most employees are forthcoming. Most witnesses readily cooperate. And your role primarily is that of fact-finder. Even when confronted with the ambiguities of a he said/she said situation, generally you need only record the statements. Let your corporate risk officer and an adjuster sort it all out.

Running a competent internal investigation is largely a matter of maintaining a neutral, nonjudgmental perspective (sometimes more easily said than done), having a well-defined, step-by-step plan — and sticking to it.

Your risk management consultant/broker should be able to help you write such a plan. (Thilman Filippini has developed a number of customized programs, using our TF Managed Risk principles). Here are a few rules of the road.

1. Do no harm. It goes without saying that prompt and appropriate medical care, if needed, is your first priority. And the main purpose of a follow-up investigation should be to prevent future accidents and promote employee safety.

Beyond this, fairness — and the perception of fairness — are the cornerstones of a successful accident investigation and eventual claim resolution. Always focus one eye on how your internal response will be viewed by other employees and in an outside forum, such as in a hearing room or even the pages of the local newspaper.

In other words, the company's interests should be in balance with those of an injured employee. The goal is fair compensation for lost time or expenses and a return to work as soon as medically feasible.

2. Work closely with the supervisor. An employee's immediate supervisor usually is the first to respond and often the most logical person to spearhead the accident investigation. He or she knows the type of work involved, the equipment used and has existing relationships with other employees or witnesses.

Make sure you and the supervisor are on the same page, literally. Naturally you'll have OSHA reporting forms and guidelines on hand, but in addition you'll need proprietary incident/accident reporting forms and procedures to move the process through its initial stages. Be sure to you report a claim within 24 hours. Do not hesitate to call your broker/consultant or corporate counsel if you're uncertain about next steps.

3. Interview the injured employee. As soon as practical, talk with your injured employee about what happened and why. Do this the same day and in person, if at all possible. Be sensitive and sympathetic without making sweeping promises. Your initial "bedside" contact — whether in a hospital, at a clinic or at the work site (following treatment and release) — often determines if a case can be handled amicably.

Document your interview and all subsequent contacts. Annotate every call, every scrap of information related to the accident — including reports from a clinic or treating physician — just in case. Create a folder in which to build a file. Your adjuster will need this material.

4. Preserve evidence. If equipment is involved in an accident, don't make repairs or allow a supplier to remove it from the premises. Preserve the accident scene — as is — until an adjuster arrives. If this isn't practical, take photographs and document what you see before moving anything. (Date and time the photos if your camera doesn't automatically do this.)

5. Gather statements. Interviewing witnesses to the accident should be a straightforward proposition: no pressure. Talk to anybody who saw what happened or comes forward with information. Even overheard remarks or after-the-fact comments by the injured worker may be appropriate to jot down. Be open.

6. Be alert to facts or statements that don't "fit." The ideal way to begin an inquiry is not looking for signs of fraud, but being aware when such indications arise. Contradictory accounts or timeframes are two obvious indicators. Here again, talk to your corporate risk officer or the adjuster.

7. Don't discuss statements or evidence with anyone outside the scope of the investigation. Enough said.

Of course, many factors are involved in the compassionate and cost-effective management of workers compensation claims — such as establishing a good relationship with an occupational health clinic. And we'll address these issues in other TF "white papers." But a prompt, thorough investigation is everyone's best interest.

Finally:

8. Don't wait for a formal claim or complaint. Be sure that supervisors take notice of any mishaps occurring on their shifts, document them and arrange for the worker to see a doctor. In today's risk environment, an employee's nonchalant assurance that "I'm okay, just give me the afternoon off" isn't okay from the liability standpoint. An ounce of preventive care and documentation is worth pounds of legal briefs.