Loss Control Standard 4

LCS #4 – Incident Investigations

Requirement:

1. Have a written procedure for conducting claims investigations.

2. Within two weeks of notification by claimant, complete written incident investigations for every Workers’ Compensation and Liability claim filed with PennPRIME/Inservco, even zero dollar.

3. Track and document corrective actions to completion.

Best Practice: Complete written incident investigations for all incidents, whether or not a claim is filed.

Measure of Compliance: Submit a completed investigation report to PennPRIME within two weeks of notification by claimant. If corrective actions are not acceptable, work with PennPRIME to develop. Annually, submit form verifying continual compliance with requirements by the end of June.

Intent: Through investigations, management and employees can glean information from these incidents to prevent future injuries to employees and the public, future property damage and able to minimize resulting costs. Lessons learned from the past prepare us for the future.

Guidance

Using an incident investigation form is not redundant with filing claims information.

• Filing the on-line, First Report of Injury form for Workers’ Compensation or filing an Acord form for an auto/property/liability claim serves to further the care of the injured parties and advance applicable reimbursements.
• Using an incident investigation form serves to identify the contributing factors of the incident so that corrective actions can be developed to prevent the incident from occurring again.

Incident investigation is a systematic effort to determine what happened, the immediate cause, the contributing factors, and what must be done to prevent it from happening again. Incident investigation focuses on improving the system rather than placing blame with an individual. If an employee gets injured, chances are that other employees doing that same task are taking the same risks, and the only reason that they haven’t had an injury is luck. By asking why the system failed, you can develop or change the system to help avoid a repeat occurrence.

Best Practices for Incident Investigation:

• To insure issues identified in the investigation are documented and appropriate corrective actions are taken, a written investigation form must be used and a written corrective action program must be implemented.
• Remember to look for and correct not only the symptom, but the contributing factors that caused the incident.
• Supervisors are responsible for:
  • Completing the investigations.
  • Developing and executing corrective actions with input from their employees.
  • Ensuring that all affected employees, including those in other departments, have been trained in any changes to the procedure (system).
  • Following-up to ensure that the corrective action plan has addressed the contributing factors of the accident/incident.
  • A properly trained Safety Committee can provide valuable assistance in conducting the investigation but primary responsibility to ensure the investigation is conducted and completed correctly, and that the issues identified by the investigation are effectively addressed, remains with management.
• In some instances, permanent action may take time. Do not ignore the situation. Instead, take whatever temporary measures are necessary to reduce the risk while a formal corrective plan is being developed.

Developing a Written Procedure

In most cases, you will need one procedure for investigating Workers’ Compensation claims and a different procedure for investigating Liability claims.

1. Identify how your entity gets notified of claims.

• For Workers’ Compensation, typically the injured employee, a coworker, or a foreman/supervisor notifies the appropriate person that an accident/injury has occurred.
• For Liability issues, there is often a variety of ways your entity gets notified of a claim. Possible notification methods include, but are not limited to:
  • Police report of a vehicle accident
  • Insurance representative
  • Lawsuit
  • Third party notifies an employee

2. Designate which employee will be responsible for gathering the information for the claim and channeling the information to the appropriate parties.

• For Workers’ Compensation, this is typically a foreman/supervisor, but could vary depending upon the structure of your entity.
• For Liability issues, it is recommended that one employee be designated to be the “project manager” of Liability claims. This person is responsible for initiating the process, delegating tasks appropriately, centrally filing paperwork, and ensuring follow-through on all aspects of the process.

3. Develop a written procedure that:

• Is specific to the type of claim you are investigating. In most cases, you will need one procedure for investigating Workers’ Compensation claims and a different procedure for investigating Liability claims.
• Identifies all responsibilities by job title and meets the unique needs of your entity.
• Incorporates the PennPRIME requirement that claims must be investigated within two weeks of notification by claimant.
• Indicates where documentation will be filed.

Revised 08/18/2022