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Mischance Examination

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  1. Accident Investigation Name, Job Title Phone number E-mail address

  2. Purpose of Presentation • Overview of workers’ compensation accident investigation process • Value of investigation following an accident (whether compensable or not) • Elements of Accident Investigations

  3. 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

  4. Employee Must Provide “Notice” Why: To notify the employer that the employee had an injury at work so that the incident can be investigated.

  5. Employee Notice of an Accident • (Insert your agency’s 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.

  6. 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 5 days

  7. 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

  8. How Can You Help? On-Site Investigator’s Role In Workers’ Compensation Claims

  9. Why Investigate WC Claims? • Executive Order 52 (99) • Needed to assist claims staff • Determine cause • Document scene • Document what people said and saw • Prevent future accidents

  10. 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

  11. Documentation Insert information here on your agency’s 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?

  12. 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 claims staff

  13. Photographs • Why are photographs so important to OWC? • Support facts • Document scene • Become the “eyes” for people not in the field • May be required if litigated

  14. Exposure to Bloodor Other Body Fluid Document: • Who is the source • Was there any possible transmission of disease • Contact with cuts, scrapes • Contact with eyes, nose, mouth

  15. Exposure to Bloodor Other Body Fluid Insert your agency’s policy on how to handle exposure incidents here.

  16. 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 worker’s or witness’s statement • Claims staff determines compensability

  17. §32.1-45.1 Code of VirginiaDeemed Consent • Covers health care workers, law-enforcement officers and 1st responders • Source can be required to give blood sample for testing • Employee or their agency has the right to access the test results

  18. Investigations

  19. What is an “Accident”? • Any unplanned event that results in personal injury or in property damage. • Not intended • Not reasonably anticipated

  20. So What is a “Cause”? • It is the reason for an action or condition; something that brings about an effect or result. (Webster’s dictionary)

  21. 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!

  22. 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

  23. 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

  24. What is the Investigator’s Role? • Do: • Go to the accident site • Investigate and document the cause • Document supervisor and witnesses • Preserve the evidence • Don’t: • Speculate on coverage • Conduct formal interviews • Give advice

  25. Guidelines for Investigators • Agency investigator should: • Survey, secure and document the site • Identify the cause • Look for contributory hazards • Report conclusions and recommendations

  26. Investigative Techniques • INVESTIGATE IMMEDIATELY! • Don’t assume anything • Obtain all possible facts • Preserve the evidence • Take photographs of the site • Take measurements and diagram if necessary

  27. Don’t 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

  28. 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?

  29. 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?

  30. Preserve the Evidence • Before you preserve it, let’s 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

  31. 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

  32. 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

  33. Weather • Sunny and clear? • Rainy? • Foggy? • Icy? • Temperature • Cold • Hot

  34. Housekeeping • Clear, unobstructed walkways • Passageways and aisles free of protruding nails, loose boards • Debris • Unwanted Clutter • Boxes in aisles • Obstacles/barriers

  35. Environmental • May include the following elements: • Stairs • Ladders (portable, extension, etc.) • Machinery, i.e. power saws • Any room, i.e. training, sleeping quarters • Walls • Furniture, such as tables or chairs • Vehicles • Sidewalk cracks (take measurements)

  36. What’s wrong with this picture?“I was working at my desk and all of a sudden I noticed pain in my left wrist…”

  37. What’s wrong with this picture?“I’ve fallen (and I can’t get up…)”

  38. What’s wrong with this picture?

  39. (Agency Name)Most Common Accidents • Struck by/ strike against • Material Handling • Slips, Trips, Falls

  40. Need Assistance ??? We’re here to help!

  41. Questions??? • Remember: • Think “out of the box” • Trust your instincts • Use common sense