What to do when an employee is injured in an auto or truck accident
When an employee is in a motor vehicle accident that Arises Out Of and in in the Course Of Employment (AOE/COE), any resulting injuries are covered under Workers’ Compensation.
Your prompt accident investigation will provide valuable information to the Workers’ Comp carrier to help determine if the claim is compensable and who was at fault.
Investigation checklist:
Did the injury occur during the commute time? (generally, not covered under Workers’ Comp but with many exceptions.)
Did the employee deviate from the route of a business trip? (example: a personal stop at the grocery store on the way to making a company bank deposit?)
Was the employee on a special mission for the employer? (generally covered under Workers’ Comp)
Was the employee driving a company vehicle or given money for gas/mileage? (may be covered under Workers’ Comp)
What to do next:
Give the employee an Employee Claim Form (DWC-1) within one working day.
Report the claim to your Workers’ Comp carrier immediately, no later than the required 5-day reporting period.
Provide the claims adjuster with the information that you have gathered from your investigation, including any third-party information or police reports.
Ask the carrier to “delay and investigate” the claim if you question whether or not the employee was “on the job” at the time of the accident.
If there is injury, the Workers’ Comp carrier is required to be the first dollar payer. If a third-party is at fault, the Workers’ Comp carrier will subrogate against the responsible driver to recover the money paid. .
Minimize the cost of the claim by accommodating an employee’s work restrictions and ensure that the carrier promptly evaluates and authorizes medical treatment that is within the medical guidelines (ACOEM) Contact your injured employee often to keep the dialogue open.
Ask the adjuster to notify you when a Complaint or Notice of Lien is filed with an at-fault driver. Note that if a public or governmental entity is at fault, the normal 2-year stature for filing a civil complaint is reduce to 6 months. Ask your carrier for a copy of the Complaint.
If the money paid by the Workers’ Comp carrier is reimbursed by the responsible third-party, the X-Mod can be recalculated and reduced to reflect the recovery.
If my employee is injured in an on-the-job auto accident due to the fault of another driver, does the claim still impact my Experience Modification (X-Mod)?
Workers’ Compensation is responsible for the initial payments of benefits, providing the accident was work-related. You must report the claim to your Workers’ Comp insurance carrier or third-party administrator as you would for any other reportable claim. Provide the claims adjuster with your accident investigation. Include the responsible party’s information and insurance carrier so that subrogation is investigated, and recovery of any money paid on the claim is pursued.
There is a 2-year statute of limitations for filing a civil suit; 6 months if the suit is against a public entity. When the Workers’ Comp claim is closed or settled, the final amount will be requested for reimbursement from the third-party.
The total amount paid in benefits may not be fully reimbursed by the responsible party. For example, there may be policy limits, comparative employee or employer negligence, or other factors that reduce the amount that is reimbursed.
The claim will be valued on your X-Mod based on the indemnity and medical reserves. However, subrogation may qualify the claim for revision of your X-Mod once the claim is finalized and money is recovered or partially recovered. The current and two prior X-Mods may be re-calculated and the revised X-Mod will be retroactively applied to the appropriate policy year.
Call your ESM Claims Advocate if you need assistance.