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How do I report a claim?
Visit our Report a Claim page.
Why are on-the-job injuries investigated?
We investigate accidents to find the cause, document the series of events, and collect witness information. All this information is crucial to the claims handling process. Another important reason for an accident investigation is to prevent it from happening again.
What is workers’ compensation fraud? What should I do if I suspect a claim is fraudulent?
Workers’ comp fraud can be “exaggeration and malingering” which is when someone claims they are unable to work due to an injury or pain when in fact, they are not. Fraud is also working or receiving unreported income. Injured workers who are receiving workers’ compensation benefits and are employed or are paid money for providing any kind of service are committing fraud. “Working” can include providing services from home such as car repair, dog walking, babysitting, lawn care, bookkeeping, selling cosmetics, etc.
If you have any questions about fraud or suspect a claim is fraudulent contact your FHM claims adjuster or the fraud unit at (888) 346-3461.
What can I expect from the claims handling process?
Your FHM adjuster is your partner in casework. By keeping in touch with each other, your adjuster can help ensure each claim is handled properly and costs are kept to a minimum. At FHM we intentionally keep our caseloads well below the industry average so our adjusters can establish a real working relationship with our policyholders. Also, our adjusters are assigned by the policyholder’s ZIP code, so they really know your geographic territory.
Depending on the claim, your FHM adjuster will be a part of a team that may include a nurse case manager, a claims supervisor or manager, legal counsel, the cost containment, subrogation or fraud units, and a risk management (claims prevention) specialist.
As an employer, if your employee is off the job, you want reliable information on their health and their ability to return to work. We are here to keep you posted with the latest information and help protect employers from fraud. Your adjuster will be up to each case and can answer your questions and go through claims reviews with you. Your adjuster will also keep you informed on any legal proceedings as well as the medical and work-ability status of your injured employee.
To contact the claims adjuster on your case, call the FHM Claims Unit at (888) 346-3461.
When a First Report of Injury is "called in," will a claim number be assigned?
Yes, a claim number will be assigned when a claim is reported via telephone.
Is it necessary to submit a First Report of Injury form after reporting it via telephone?
No. FHM will draft the First Report of Injury from the telephone report and send copies to the employee, employer and the State.
Because I am reporting online/faxing/calling in the First Report of Injury, must I still maintain the OSHA log?
Yes. OSHA record keeping requirements can be reviewed online at www.OSHA.gov. Be sure you are not exempt from recordkeeping.
If reporting by fax, do I need to wait until the employee can sign the form before reporting?
No. Never delay reporting because you do not have the injured employee's signature. Indicate "not available" if the employee is not available for signature and submit the report immediately.
What if I don't report the accident/injury in a timely manner?
A failure by the employer to report the accident/injury to the workers’ compensation carrier in a timely manner can result in the employer incurring a fine.
Must an employer report all accidents/injuries?
Injuries that require first aid treatment only need not be reported.
If an employee violates a safety rule, are they covered by workers' compensation?
Yes. Even if an employee is injured while violating a work rule, they are usually covered by workers’ comp insurance. Ignorance or bad judgment alone will not usually lead to a denial of benefits. Repeated violations of safety rules, however, may lead to a reduction of indemnity benefits if the employer is able to show that the employee had been disciplined in the past and there is documentation to this effect. Advise your FHM Claims Adjuster, if this is the case, when the claim is reported. This may help to effectively reduce the ultimate cost of the claim. You also may want to ask your FHM Risk Management Consultant to help with setting up safety programs and training
If an employee is injured at a company-sponsored picnic, are they eligible for workers' compensation?
If attendance is mandatory, the picnic is held during business hours and the employer derives a benefit from it beyond improved employee health and morale, then the employer will more than likely be responsible for any injuries that may arise. To prevent extracurricular activities like this from boosting your workers’ compensation costs, try implementing these strategies:
Make attendance optional. If not, you run the risk of making it a condition of employment and increasing your liability if someone gets hurt.
Don’t demand that workers help with set-up and serving. Ask for volunteers. A “special job task” (one that is “concurrent” to the job even though it’s off-hours) may also increase your workers’ compensation liability.
Ban contact sports. Choose games and activities which don’t significantly increase the risk of employee injury.
Limit alcohol consumption and provide transportation provided by the company. Or better yet, ban it altogether. If you want to allow some drinking, try limiting employees by using drink tickets or curtailing the amount of time in which alcohol is served.
Can employees collect workers' compensation benefits for injuries sustained while they are off company premises?
While workers’ comp laws are state-specific, most follow the basic rule that injuries that occur “in the course of” and “arise out of” the worker’s employment are covered.
For an injury to be considered as having occurred in the course of employment, the employee must have sustained it while performing work or engaging in an activity that is logically related or incidental to the employer’s business.
In order to make the connection that an injury arose out of employment, test these three factors:
The proximity of the scene where the employee was injured to their place of work;
The amount of control the employer has over the scene of the injury; and
Any benefits the employer may have received from the employee’s presence at the scene of the injury.
Your state workers’ compensation law may also have a special hazards rule. In general, an employee can collect if they can prove that the employment relationship exposed them to a greater risk than that faced by the general public
What is an employer’s responsibility if an employee cannot physically perform the job they were hired to do upon their return from workers’ compensation leave?
Workers’ compensation statutes vary from state to state regarding whether you must restore employees to their original jobs upon their return from workers’ compensation leave. Some workers’ compensation laws require that the employee be reinstated to a part-time or a transitional-duty job which meets the restrictions given by their treating physician until they can resume working in their old position. It’s best to check with your state’s particular workers’ compensation law.
However, the workers’ compensation law may not be your only concern. If this employee’s injury qualifies as a disability or serious health condition, you may also have to contend with the Americans with Disabilities Act (ADA) and/or the Family and Medical Leave Act (FMLA).
According to the ADA, you have a responsibility to accommodate an employee with a disability who is returning from leave if an accommodation is available that would enable the employee to perform the essential functions of the job. Reassignment to another position may be considered an accommodation if the employee with a disability can no longer perform the essential functions of their original job.
The FMLA, on the other hand, guarantees job protection. Thus, employees returning from workers’ compensation leave, who also took concurrent FMLA leave, are entitled to their former (or equivalent) positions. However, the FMLA stipulates that if an employee is unable to perform an essential function of the same or an equivalent position because of a physical or mental condition, you aren’t required to reinstate them into another job.
Be sure to check with the ADA and FMLA web sites to see if you are subject to their requirements.