Northwest Specialty Hospital : Manager Accidents

1593 E. Polston Avenue · Post Falls, ID 83854 · ph: (208) 262-2300 · fax: (208) 262-2390

Ear, Nose and Throat department at Northwest Specialty Hospital

Occupational Medicine Home >> Employee Information >> Manager Information

Worker's Compensation:

Manager Information: When Accidents Happen...

Your employee was injured and you know there is a process that needs to
get activated quickly. The focus of this section is to put detail around this process
and answer additional questions you may have

My staff member was injured at work. What do I do?
Who pays for the cost of my staff member's medical care?
How is it determined whether the injury is covered under worker's compensation?
How long does it take to recieve a determination?
Who lets my staff members know the outcome of the review?
Who should my staff members or I contact if we have questions about the
decision or the forms?

My staff member was injured at work. What do I do?

If the injury requires emergency medical care, direct your staff member to immediately seek treatment at the nearest Emergency Room. After he or she is stabilized, they will receive any necessary additional medical care within the established medical provider network. You and your staff member should complete the incident report within
24-hours of the injury.

If the injury is less severe but still requires medical treatment, please have your staff member proceed directly to the nearest Employee Occupational Health office. Please make sure that you and your staff member complete an injury report and have your staff member bring it with them when they receive treatment.

If the injury does not require medical care, still complete
an incident report. Knowing where and how staff injuries occur enables us to investigate, track, and take corrective action before someone else is injured (possible more serious next time).

Best Practice Tips:

If possible, have another staff member accompany your employee who can help provide information about the cause of the injury to the medical care provider as well as your injured employee's family members.

When possible, have your staff member call ahead to make an appointment to see one of the physicians to cut down on the amount of time he or she spends in the waiting room. Reassign or reprioritize your staff member's job responsibilities as needed while waiting for the appointment.

Completing your portion of the incident report requires you to investigate the circumstances around why the injury occured and what can be done to prevent its reoccurence. Some causes of injury may be easy for you and your staff to correct such as restraining on existing safety procedures, removing tripping hazards, or regularly reminding all your staff to have heightened awareness about their own safety as well as their colleagues.

Other causes of injury will require you to bring in expert assistance such as our staff Ergonomics in the Safety department or to contact facilities management for repairs. Be sure to note the actions you are taking to prevent reoccurence on the incident report.

Remember to complete the report as soon as possible. Employees should complete the report during the shift in which the injury occured and you should complete the report within 24-hours.

A report is "late" if it is completed more than 10-days after the injury. Late reports result in the department being financially responsible for any workers' compensation wage replacement paid to the employee as a result of the injury.

Who pays for the cost of my staff member's medical care?

The cost of your staff member's medical care is paid through workers' compensation when the treatment is authorized, provided by an approved provider, and the injury is accepted as a workers' compensation claim. This means they would not be responsible for deductibles or copays for authorized treatment. Your staff member will need to let the provider know that the treatment is being provided for an on-the-job injury each time he or she recieves medical care.

If your staff member's injury requires medicine, they will be provided a pharmacy card to cover the cost of the prescription. The card is specific to medications for the workers' compensation injury and do not require any co-pays, just prior authorization.

The timely completion of the incident report by you and your staff member speeds the review process so that questions regarding whether the injury and the associated costs are covered can be answered as quickly as possible.

How is it determined whether the injury is covered under workers' compensation?

Each incident report is electronically forwarded to the Workers' Compensation Office. Reports that indicate that either medical care was needed or where more information is needed to determine compensability are assigned to a Claims Specialist. Each specialist is a licensed adjuster who is experienced and knowledgeable regarding workers' compensation. The specialist will interview your staff member regarding the incident, their relevant medical history, and relevant outside work activities to gather the necessary information to determine whether the injury can be covered under workers' compensation. If the circumstances are very complex, the specialist may also consult with legal counsel and/or request to review the relevant medical records, and/or request additional information from you. Once the review is completed, a decision is made regarding whether the injury is covered under workers' compensation.

How long does it take to receive a determination?

Generally, first contact with your staff member to obtain additional information regarding the incident is made within two business days of receipt of the incident report within Workers' Compensation and a determination regarding compensability is made at that time. If your staff member is unavailable or additional information is needed, the process will take longer. Please encourage your staff member to respond to a request for information from the Workers' Compansation Office as soon as possible.

Who lets my staff member know the outcome of the review?

The specialist will let your staff member know the outcome of the review. The informal process is to let them know by phone so that any necessary additional care can be directed appropriately (i.e. continued treatment with Employee Health or via their family physician). There is also a formal written notification process that is required by the state, this formal process is intensely form driven. The required forms are sent to your staff member along with an explanation letter regarding the purpose of the forms.

Who should my staff member or I contact if we have questions about the decision or the forms?

You and your staff member are welcome to contact the specialist regarding the decision. You are both also welcome to request that the decision be re-reviewed by the claims manager. In addition, the Workers' Compensation Board is the state's administrative agency responsible for administering all workers' compensation claims in the state. An ombudsman at the Board is available to your staff member at no charge who can help answer questions regarding claims and to help your staff member through the process of appealing a decision if he or she does not agree with it.

^ Back to Top ^