Where the employer still has a stake
Once a claim is filed, the insurance carrier usually handles its defense, but the employer's role does not disappear. The facts the carrier relies on, such as how the injury was reported, what the job required, and what supervisors saw, mostly come from the employer's own people and records. Claims can also affect premiums and experience ratings well into the future, so how a claim is documented has a business cost. Self-insured employers and members of group trusts carry more of the work directly. When a business had no coverage, the New York Workers' Compensation Board can assess penalties, and the injured worker may be able to sue the employer directly.
Records that support a fair defense
Keep the first report of injury, any written statements, the job description, schedules, and video if it exists, and route them to the carrier promptly, since the employer has reporting duties of its own. Communicate with the injured employee about return to work and light duty in writing, and avoid anything that could look like discouraging a claim, because retaliation against a worker for filing is prohibited. If you suspect a claim is exaggerated or not work-related, share the facts with the carrier rather than confronting the employee. Fraud concerns go through the carrier and the proper authorities, and any investigation by the employer itself should be planned with counsel.
What we look at first
We start with coverage: whether a policy was in force, whether the injured person was an employee or a contractor, and whether another company, such as a general contractor or a staffing agency, should be responding. Then we look at the claim itself, the medical evidence, and the defenses the facts support. Penalties for lack of coverage, a stop-work order, or a lawsuit outside the comp system each move on their own timeline. For employers with repeated claims, we can also review safety practices and reporting procedures so that the next claim is documented properly from the start.
