We hear employers all the time saying, “I think the claim is fraud”, “I don’t agree with the insurance adjuster”, “It was just bad luck”, etc.

As a first step, the following should always be researched for insight:

1.)  What did the video footage reveal?  Was video 30 minutes prior and 30 minutes after saved? Was this info. communicated to the adjuster?

2.)  What do the accident investigation forms completed at the time of the incident reveal?

3.)  What did the Additional Statements taken via Statements form reveal?

4.)  Was anything revealed in the Accommodation Form the employee completed when hired?  For example, prior injury disclosed, the need for special accommodations, or the need for job duty restrictions.

5.)  Was the employee fit for the job based on the documented Job Description?

6.)  What did the manager on duty say about the incident?

7.)  Was the incident reported to the insurance company within 24 hours of it occurring?

8.)  Was all the documentation above provided to the insurance company adjuster within 48 hours of the incident?

9.)  Have procedures been put in place to help prevent this from occurring in not only this store, but in all stores?

10.)  Has the incident been communicated to all managers (across all stores) so that they understand how this impacts the business and to increase safety awareness?