Report Workers' Compensation Claims When They Happen

Report Workers' Compensation Claims When They Happen

Reporting all workers’ compensation claims promptly is a critical component to controlling workers’ compensation claim costs.

Financial Effects of Late Reporting

The financial effects of late reporting can be significant, as the average cost of a claim is typically higher if it is reported late. There are several reasons for this:

  • A delay in seeking treatment may cause a deterioration in the employee’s condition that will impede the employee’s recovery time.
  • An insurance carrier’s ability to investigate a claim, determine compensability and identify potentially fraudulent claims may be hindered.
  • The ability to deny uncompensable claims can be impacted as many states have regulations that prohibit denial of claims after a specified time period. The ability to deny a claim due to a worker being under the influence of drugs or alcohol can also be impacted by reporting delays.
  • The opportunity to direct the initial treatment to an occupational health clinic that specializes in treating workers’ compensation injuries and coordinates with the employer’s Return to Work program may be lost.
  • The benefits of using nurse case managers or other managed care initiatives to effectively manage the care of the worker can be limited with late notice.
  • Many states have prompt reporting requirements and impose fines if an insured reports a claim late or fails to report a claim. OSHA has claims reporting requirements for certain claims that may not be met if reported late (note that effective January 1, 2015, new, more stringent OSHA reporting requirement apply).

Financial Effects of Late Reporting

Per the Florida Department of Financial Services:

If the First Report of Injury (DFS-F2-DWC-1) is filed late with the Division, due to the late reporting of the accident by the employer to the insurance company, the employer may be penalized for the late filing, according to the following schedule:

* $100 for 1 through 7 days of untimely filing.
* $200 for 8 through 14 days of untimely filing.
* $300 for 15 through 21 days of untimely filing.
* $400 for 22 through 28 days of untimely filing.
* $500 for over 28 days of untimely filing.

In addition to the above administrative penalty paid to the Division, the employer may be liable for penalties and interest on the late payment of compensation, due to the late filing.

Additional Resources

www.MyFloridaCFO.com/Division/WC/

Workers’ Compensation System Guide