Avoid Regulatory Fines by Reporting Claims Timely

Staffing agencies can help ensure the pool of qualified candidates keeps pace with demand for teachers and support staff, but leadership needs to understand the risks. If a vendor’s employee suffers a workplace injury, your response—or lack of response—could lead to unnecessary claims costs and regulatory fines.

Scenario

The Fund received multiple workers' compensation claims that followed a similar script: XYZ ISD partnered with Subs R Us to hire a substitute teacher named John. One day, John fell from a ladder and broke his arm while hanging student art.

He told his doctor the accident happened while he was working at XYZ ISD. The Fund provides workers' compensation coverage to XYZ ISD, so the doctor sent the medical bill to us.

Because we had no record of the incident, our claims team reached out to the district for a First Report of Injury (FROI), but we did not receive a response. To meet the state’s timelines, we were required to accept the claim without getting additional information from the district.

Issues

The costs that come with John’s hypothetical claim could make a real impact on the Fund generally and on XYZ ISD specifically:

• The Fund is a self-insured risk pool, so every member has a stake in controlling claims costs. Subs R Us was responsible for John's claim, but we paid it because we didn't have the information we needed.
• If you had an off-the-clock accident in your personal vehicle, you wouldn’t be surprised if your auto coverage premiums rose. The same principle applies in workers' compensation. The trickle-down effect of John's claim could unnecessarily impact XYZ ISD’s Fund coverage contributions.
• The Texas Department of Insurance, Division of Workers’ Compensation could fine XYZ ISD up to $25,000 for not filing a FROI on time.

Solutions

The confusion around John's claim could have been avoided if he told the doctor he worked for Subs R Us, not XYZ ISD. Still, it’s an easy oversight to make. After all, John reports to work in district classrooms, not the Subs R Us corporate office. He's also responsible for following district policies and procedures.

So, how can you partner with vendors to fill staffing gaps and avoid unnecessary claim costs and regulatory fines?

1. Report Claims Timely

 A First Report of Injury must be filed with the Fund within eight days on the following claims:* 

• Employee lost one day of time, not including the date of the accident
• The reported injury is an occupational disease. Occupational disease means a disease arising out of and in the course of employment that causes damage or harm to the physical structure of the body, including a repetitive trauma injury. These incidents must be filed regardless of lost time. 
• Death of an employee from a work-related injury or illness
• Employee seeks medical treatment for an on-the-job injury

*Contact your TASB claims manager if an employee collapses at work.

2. Respond to Our Team

If we receive medical bills for injuries that haven't been reported to us, our claims team will reach out. Notify us if your Fund claims contact changes, and make sure someone responds to us timely.

Timely Reporting is More Than a Workers’ Compensation Priority

Whether you participate in one Fund coverage program or all five, here are just a few reasons you should notify us about potential claims as soon as possible:

• Timely reporting is a responsibility of Fund membership. Claims might not be covered if you don’t report them within the timeframes noted in your coverage agreements.
• When you report claims, we investigate to determine whether they are compensable (covered) under the law and/or your coverage agreement. Timely reporting helps ensure evidence is available and witnesses’ memories are fresh.
• Losses sometimes grow the longer they go unaddressed. For example, minor hail damage on a roof can erode and cause leaks that harm the roof and everything inside.
• The sooner you notify us, the sooner we can start working to resolve your claim cost-effectively and help you return to normal operations.

Need Help Reporting Claims?

Fund members can report claims online, by email, phone, or fax. We offer claim-reporting guides for members with Fund Members with Workers’ Compensation, Auto, Liability, and Property coverage.