AccidentInvestigationforWorkers’CompensationClaims：對工傷事故調(diào)查索賠.ppt

Accident Investigation,Sample Training PowerPoint,Purpose of Presentation,Overview of workers compensation accident investigation process Value of investigation following an accident (whether compensable or not) Elements of Accident Investigations,Goals & Objectives,Increase your knowledge of the workers compensation accident investigation process Identify methods of investigation Determine the causes of accidents Identify tools used in the investigation process Fine tune your accident investigation skills,Employee Must Provide Notice,Why: To notify the employer that the employee had an injury at work so that the incident can be investigated.,Employee Notice of an Accident,(Insert your agencys reporting policy and key process steps) Immediate written notice required Enables prompt investigation of facts Allows employer to provide necessary medical attention If the employer does not investigate, may not be able to prove the facts.,Best Practices,Injured worker should immediately notify his/her supervisor The supervisor should investigate or notify whoever is responsible for agency investigation immediately! Submit claim within 24 hrs.,Investigate to Determine Greater Risk,Injury arises from a risk not shared by the general public There is a causal connection between the injury and the employment Employee exposed to a particular danger The risk is peculiar to the employment,How Can You Help?,On-Site Investigators Role In Workers Compensation Claims,Why Investigate WC Claims?,Needed to assist claims staff Determine cause Document scene Document what people said and saw Prevent future accidents,Documentation,Document information you hear Document the scene through photographs, sketches, written descriptions, video recordings Document evidence of non-work injury Investigate facts that contradict injured workers version Investigate personnel or disciplinary problems that impact the claim situation,Documentation,Insert information here on your agencys policy Do you have internal forms? Where does the investigator get the forms? Who does the documentation go to for forwarding to the claims staff? What timeframes are in place for completing the investigation? Any timeframes for follow-up for correction of hazards?,What Else?,Gather contact information on witnesses & supervisors Obtain witness and supervisor names, phone numbers, best time to contact Provide this information to agency personnel to forward to WSI claims staff,Photographs,Why are photographs so important ? Support facts Document scene Become the “eyes” for people not in the field May be required if litigated,Exposure to Blood or Other Body Fluid,Document: Who is the source Was there any possible transmission of disease Contact with cuts, scrapes Contact with eyes, nose, mouth,Exposure to Blood or Other Body Fluid,Insert your agencys policy on how to handle exposure incidents here.,WSI Claims Staff Role,Claims staff receives information from agency Will investigate the Who, What, Where, When and How questions May call with additional questions or to obtain the injured workers or witnesss statement Claims staff determines compensability,Investigations,What is an “Accident”?,Any unplanned event that results in personal injury or in property damage. Not intended Not reasonably anticipated,So What is a “Cause”?,It is the reason for an action or condition; something that brings about an effect or result. (Websters dictionary),Accident Investigations,The failure of people, equipment, supplies or surroundings to behave or react as expected causes most accidents. Accident investigations determine how and why these failures occur. Conduct with prevention in mind NOT to place blame!,Why Should the Agency Investigate?,Assist workers comp claims process To be the “eyes and ears” in the field To gather facts on-site To preserve evidence that may be lost over time To determine cause of the accident To identify ways to prevent accidents from recurring,Best Practices,Make sure the injured worker is taken care of first Secure the scene to preserve the integrity of the scene Gather all necessary equipment to begin investigation,What is the Investigators Role?,Do: Go to the accident site Investigate and document the cause Document supervisor and witnesses Preserve the evidence Dont: Speculate on coverage Conduct formal interviews Give advice,Guidelines for Investigators,Agency investigator should: Survey, secure and document the site Identify the cause Look for contributory hazards Report conclusions and recommendations,Investigative Techniques,INVESTIGATE IMMEDIATELY! Dont assume anything Obtain all possible facts Preserve the evidence Take photographs of the site Take measurements and diagram if necessary,Dont Make Assumptions,Gather the facts What did the injured worker say happened? What did witnesses see? What did the injured worker tell witnesses? Talk to the supervisor,What Do You Ask?,What did the injured worker tell you? Where and when did the accident occur? Were there any witnesses? How was the employee injured? Was training provided for this task? Were the safety rules followed?,Additional Questions for the Supervisor,Was the employee doing an assigned task? Had the employee been trained on the task? Had the employee ever done this task before? How often is this task performed?,Preserve the Evidence,Before you preserve it, lets define it: Evidence is data, which helps to prove the event Next, decide what evidence is important Immediate photographs are critical The site could change the next day and evidence would be lost,What Do You Photograph or Videotape?,Sites of accidents, including: Defects Hazards Unusual Conditions Conditions that differ from what the employee describes Areas or furniture in need of maintenance Housekeeping issues,What to Look For?,Liquid substances or objects on a floor Worn treads Slippery floor (heavy wax) Loose rungs on a ladder Frayed or torn carpet Type of shoes Anything being carried Anything out of the ordinary,Weather,Sunny and clear? Rainy? Foggy? Icy? Temperature Cold Hot,Housekeeping,Clear, unobstructed walkways Passageways and aisles free of protruding nails, loose boards Debris Unw