Opioid-involved drug overdoses topped 100,000 in 2022, according to the Centers for Disease Control and Prevention (CDC).

And another 10 million people misused prescription opioids in 2019, reports the U.S. Department of Health and Human Services .

Opioid painkiller misuse has become widespread, affecting every facet of life – and that includes the workplace. It not only threatens the general well-being of employees, but it can also create on-the-job safety risks and inhibit recovery and return-to-work.

Opioids do have their place when properly prescribed and used, but their misuse can have devastating effects on your employees.

Here are some basics for employers on opioids and opioid misuse:

What are opioids?

Opioids are narcotic painkillers that work by preventing pain signals from reaching the brain. They are synthetic drugs that resemble the effects of natural opium, derived from the opium poppy. OxyContin and Percocet are a couple of the popular brand-name opioids, but there are many more. Taking them may produce a euphoric effect, or “high.”

Why are they prescribed?

Opioids are generally recommended for short-term pain relief due to injury, surgery, disease or cancer treatment, or as a palliative measure for the terminally ill, but doctors also prescribe them to address chronic pain.

However, due to increasing opioid prescriptions for chronic pain, and a related increase in overdose deaths, the CDC issued guidelines for prescribing opioids. The guidelines are intended for primary care clinicians and other clinicians providing pain care for outpatients 18 years or older with:

• Acute pain (duration less than 1 month)
• Subacute pain (duration of 1-3 months)
• Chronic pain (duration of more than 3 months)

Are they necessary and effective?

Studies show that long-term use of high doses of opioids usually isn’t the best treatment for chronic pain, unless the patient is terminal.

In fact, nonopioid therapies are at least as effective as opioids for many common types of acute pain, according to the CDC.

“Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient,” reads a portion of the guidance from the organization.

Using the drugs long term can actually increase a patient’s sensitivity to pain, requiring higher doses for the same level of pain relief. This escalating dosage pattern can contribute to opioid addiction. Also, opioids are not among the most effective – or longest lasting – options available for relief from acute dental pain, an examination of the results from more than 460 published studies has found.

In addition to the risk of tolerance and addiction, according to a CDC factsheet , other side effects of taking opioids can include: constipation, nausea, vomiting, dry mouth, sleepiness, dizziness, confusion, depression, lower testosterone (resulting in lower sex drive, energy and strength), itching and sweating.

What about other treatment options?

A 20-year analysis of health care treatment released in early 2024 revealed a significant rise in use of complementary health approaches, such as yoga and meditation, especially for pain management.

The analysis , conducted by the National Institutes of Health’s National Center for Complementary and Integrative Health and published in the Journal of the American Medical Association, found that the percentage of individuals who reported using at least one of seven alternative approaches to care increased from 19.2 percent in 2002 to 36.7 percent in 2022.

For pain management, the use of alternative therapies increased from 42.3 percent in 2002 to 49.2 percent in 2022.

Researchers utilized data from the 2002, 2012 and 2022 National Health Interview Survey to evaluate changes in the use of seven complementary health approaches, including yoga, meditation, massage therapy, chiropractic care, acupuncture, naturopathy and guided imagery/progressive muscle relaxation.

How likely is it that one of my employees will suffer from opioid addiction?

In 2022, there were 39.5 prescriptions written for every 100 people in the U.S., although some counties had rates above 51 per 100 people, according to CDC prescribing rate maps . That 39.5 figure is down from 46.8 in 2019.

Opioid abuse has become so pervasive that any employer should be conscious of the possibility that an employee could be affected. The U.S. Health and Human Services Department declared the opioid crisis a public health emergency in 2017.

About 3 million people in the U.S. have had or currently suffer from what the National Library of Medicine calls opioid use disorder (OUD) as of July 2023. The group says the increase in OUD can partially be attributed to the overprescribing of opioid medications.

As an employer, how does this issue affect me?

The most important aspect of the opioid addiction epidemic is its potential to significantly impact the well-being of your employees, whether they themselves are misusing the drugs, or they’re dealing with the stress of a loved one’s addiction. Any drug addiction can have numerous negative effects like harming family relationships, threatening financial stability and even causing death.

Employee opioid use can also affect workplace safety. Employees taking opioids (even if not addicted) could pose a safety risk to themselves and other employees, depending on the kind of work they do.

• The behavior of someone on opioids can be similar to that of someone who has been drinking
• Jobs that involve working from heights, being on construction sites and driving are among those that cannot be safely performed while on opioids

An employer might choose to have a policy preventing employees from performing these kinds of tasks while taking drugs, like opioids, that can diminish alertness.

State laws differ on employee drug testing, and additional legal issues such as compliance with the Americans with Disabilities Act can come into play, so it’s wise to consult legal counsel before instituting a formal policy.

What’s being done to combat the trend of opioid abuse?

Medical providers, pharmacists, insurers and government agencies are all taking steps to combat the epidemic.

Doctors are assessing patients’ risk factors for misuse of opioids more carefully before prescribing them. More doctors and pharmacists are also participating in prescription monitoring programs, which are statewide databases listing all prescriptions of controlled substances and when those prescriptions are filled.

These systems allow doctors, dentists, pharmacists and law enforcement to see whether a patient is getting multiple prescriptions from different doctors, or filling the same prescription in multiple places.

Some physicians also use narcotics contracts to better control patients’ use of opioids. These contracts typically prohibit a patient from getting pain medication prescriptions from other doctors. Many physicians will obtain random drug testing to ensure that patients are taking their medications as prescribed.

Insurers are often requesting peer-to-peer reviews when they question whether an injured employee is being prescribed the most appropriate medications. In these cases, a pharmacist and pain management specialist will look at the case and talk with the treating physician about their course of action. SFM has expert staff who review opioid prescriptions and works with treating physicians and claimants to help wean them off the drugs.

Lastly, the CDC has issued federal guidelines for prescribing opioids for chronic pain. The states of Minnesota, Wisconsin, and many others, have issued state treatment guidelines.

Additional resources

• National Safety Council opioid resources
• Opioid Epidemic Response: Employer Toolkit

This blog was originally published in December 2022 and updated in February 2024 with new information and additional research.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Many employers don’t realize how much control they can have over their workers’ compensation premiums.

Because premiums are based partially on your loss history, you can avoid future premium increases (and maybe even see some reductions) if you take steps to prevent injuries and ensure your claims are well managed.

Of course, it’s always a good idea to get ahead of potential injuries. Being proactive and building a safety culture in the workplace helps. This can include:

• Creating safety committees
• Implementing safety walks
• Checklists to encourage safety
• Regular safety discussions between employees and leadership

Below are some of our top tips for controlling your losses and, as a result, your workers’ compensation premiums.

1. Have a list of transitional jobs ready for when you need it

List light-duty, transitional jobs that fit within a variety of work restrictions.

That way, when employees are injured, you can easily identify jobs that fit within their restrictions and get them back to work quickly. Delays of even a day or two can increase claims costs substantially by triggering wage-loss payments that would otherwise be unnecessary.

2. Consider all your options to bring the employee back to work quickly

Bringing employees back to work when they’re still recovering can sometimes require a little creativity. A few options include:

• Reducing the employee’s work hours or work days
• Bringing the employee back in a different position at a reduced wage
• Modifying the employee’s equipment or work area
• Swapping tasks with other employees or reorganizing work within the injured employee’s group
• Arranging for temporary work in a different area of the company
• Creating a new lighter-duty job that will be transitional and temporary

Many employers don’t realize that if they bring injured employees back to work at less than their full pre-injury wage, their workers’ compensation insurance will make up most of the difference.

3. Have a relationship with an occupational health clinic

Quality of treatment counts for a lot in medical costs and outcomes.

To find a good clinic, ask officials there whether they have experience treating injured employees and accommodate return to work so the employee can heal while on the job. Ask what information they’ll need from you in the event of an injury, such as an injured worker’s job description.

4. Have a point person for return to work

It helps to have one person who is accountable for getting injured employees back to work as soon as medically possible.

This generally includes staying in contact with the employee, working with the treating doctor and involving the employee’s supervisor.

5. Ensure that employees understand and follow any work restrictions

When injured employees don’t follow their doctors’ restrictions, it can result in costly claim complications.

Take the time to go through employees’ restrictions with them and discuss any aspects of the job that could cause them to do work beyond what their doctor has permitted. Also make sure they know they should follow their restrictions both at work and outside of work.

6. Stay in contact with your injured employees

Let injured employees who are off work know that you are concerned about their injuries and recovery, that you value what they bring to the organization and that you are looking forward to their return.

Keep up on the status, expectations and return-to-work date for each injured employee. Have a plan and stay in touch with the employee, supervisor and claims representative to make sure things stay on track.

7. Report injuries right away

As soon as you learn of an injury, the clock starts ticking toward state deadlines for paying or denying benefits.

Reporting right away keeps you in compliance with these laws and regulations, and allows your claims representative to be responsive to your employees. Delayed reporting can result in longer-duration claims and higher costs. (See our injury reporting page for ways to report.)

Watch out for communications breakdowns. Employees and supervisors need to know who to contact when an injury occurs, and your organization’s point person for reporting claims needs to act with a sense of urgency.

8. Analyze past injuries

Anytime an injury occurs, conduct an accident analysis to identify what caused it and how similar accidents can be prevented in the future.

You can also use your loss history reports to help spot problem areas and identify opportunities to improve safety.

9. Develop a wellness program

Studies show there is a connection between health issues — such as obesity, diabetes and hypertension — and higher workers’ compensation costs.

But that’s only one benefit of finding ways to encourage wellness among your workforce. Encouraging healthy lifestyles can also raise productivity and reduce health care costs.

Bonus tips

Hire smart

Make sure you’re hiring the best possible employees. Legally, you can’t ask job candidates whether they’ve had past workers’ compensation claims, but you can explain the job and its requirements and ask during the interview or in an application whether the applicant can perform the essential functions of the job. Be sure to explain the importance of safety, especially in jobs involving physical labor. Take the time to look into candidates’ backgrounds and talk to their former employers.

Pay close attention to safety

Establish good safety rules and watch for things that cause workplace accidents. Look for any patterns in what’s causing injuries. Correct employees with unsafe habits and promote the importance of workplace safety.

Originally posted May 2017; updated January 2025.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

It’s not hard to find a story on prescription drugs in the headlines.

Maybe you’ve seen news reports on topics such as:

• Prescription drug abuse, which has reached epidemic proportions
• Arguments of overmedication and the push for non-pharmaceutical or non-narcotic alternatives
• Lack of affordability, with pricing increases far outpacing inflation

These issues and many more can come into play when prescription drugs are needed to treat work injuries.

That’s why SFM works hard to make sure injured employees’ medications are managed well. As part of that effort, we partner with pharmacy benefits manager, myMatrixx .

myMatrixx negotiates pricing for prescription drugs and monitors whether comparable, lower-cost drugs might be available. But its services go beyond cost savings. SFM and myMatrixx work together to see that injured employees are getting the best prescription drug treatments for their injuries and aren’t being put at risk for addiction or dangerous interactions.

The safety of our injured employees is critical.

As a pharmacy benefits manager, myMatrixx acts as an intermediary between SFM and pharmacies, negotiating and paying for medications needed to treat work injuries and connecting the appropriate representative when the medications require approval.

myMatrixx has pharmacists on staff who work together with SFM’s medical experts.

How does SFM ensure injured workers are getting safe and effective prescription medications?

myMatrixx provides SFM with reports that give us the opportunity to monitor injured employees’ prescriptions. This allows us to address dangerous combinations of drugs, prescriptions that are higher or lower than recommended doses of medications, and ineffective treatments for injuries.

For example, in one case an employee complained that his prescription drug wasn’t helping him. SFM discovered he wasn’t taking a high enough dosage for it to work.

If there is any concern about a drug(s), SFM can send a letter to the employee’s doctor. Optimal, safe and appropriate medication management is our goal.

How do SFM and myMatrixx control prescription drug costs?

The cost of prescription drugs in the U.S. increased 15.2 percent from 2022 to 2023, according to an October 2023 report from the U.S. Department of Health and Human Services. In fact, more than 4,200 drug products saw price increases.

However, it should be noted that the Inflation Reduction Act, passed in 2023, has a provision aimed at lowering prescription drug costs.

Still, prescription drug spending increased 8.4 percent to $405.9 billion in 2022, according to the Centers for Medicare and Medicaid Services .

Costs for individual drugs can vary widely, sometimes for no obvious reason. Here are a few examples of surprising variations in prescription drug pricing:

• When a manufacturer changed its pricing in January 2023, one drug’s cost went up 3,000 percent
• Some drugs can vary from $15 per dose to more than $140 at pharmacies within a single ZIP code
• A generic medicine could cost $7 or $393 depending on where it was purchased

The world of prescription drug pricing can be complicated at best and downright baffling at worst.

This is why working with a pharmacy benefits manager is so important.

myMatrixx negotiates with its network of 65,000 pharmacies on drug pricing and monitors prescriptions to identify whether identical or comparable drugs might be available at lower prices.

What is SFM doing to prevent opioid addiction?

One major reason prescription drugs have been getting so much attention recently is the sharp increase in prescription painkiller addiction as well as other medications and/or concerning combinations of medications, both legal and illegal.

SFM helps prevent addictions and advocates for weaning patients off the drugs, or at least getting them to a safer dosage.

Company officials send letters to treating physicians of injured employees who’ve been prescribed high doses of opioid painkillers or other drugs of concern, asking them to develop plans to wean the patients off of the drugs. With increased awareness of the dangers of opioids as well as other prescription medications/combinations and the concerns for prescription use disorder or addiction, more and more doctors are complying.

According to CDC, chronic pain is a pervasive health condition affecting as many as one in five adults and nearly one-quarter of them have used a prescription opioid in the past 3 months and this is associated with increased risk for misuse, addiction, morbidity and mortality.

In some cases, injured employees themselves request to be weaned off the drugs due to safety concerns after seeing the letters outlining the risks.

Sometimes, simply tapering down the medication over time isn’t a safe option. In cases of long-term, high-dose opioid use, other dangerous drug combinations, or both, SFM has sent injured employees to rehabilitation programs. These programs focus on non-medication pain management treatment/alternatives as they help people stop using their opioid painkillers.

Overall, SFM has been successful in helping many of our injured employees taking opioids or other prescription drugs discontinue use or decrease to a safer dosage.

Originally published November 2021; updated January 2024.

Your employee was injured at work. You took care of the employee’s immediate medical needs and reported the incident to your workers’ compensation insurer.

What’s next?

You can help prevent similar injuries, get the employee on the road to recovery and ensure a smooth claim process by doing the following:

1. Investigate the incident

The goal of investigating isn’t to find fault, but to understand exactly what happened so you can make sure the same type of injury doesn’t happen again.

Go to the scene of the accident and talk with witnesses to learn what happened. Take photos. Save any equipment involved. Our post on workplace accident analysis tells you how to prepare to investigate incidents and even provides a checklist that can help you think through what happened and how your organization can prevent similar incidents in the future.

2. Consult with your claims representative

Notify your SFM claims representative right away if the employee will be off work. This ensures that the claims representative will have enough time to get wage-loss benefits paid before your state’s deadline.

When the injured worker is released back to work, call your representative. Make sure you’re aware of the status of the claim and the employee’s treatment schedule, and don’t hesitate to ask questions.

3. Stay in contact with the injured employee

Make a call or a visit as soon as you can. It’s important to answer any questions an injured employee has about the expected recovery and return to work.

It’s not uncommon for injured employees to become isolated or depressed and fear they won’t have a job to return to. Reaching out to them early and often reassures them you care about their well-being and are looking forward to their return to work.

For more details on this topic, read our post about staying in contact with injured employees.

4. Arrange for return-to-work

As soon as a doctor clears the employee to return to work, find a way to bring the employee back, even if medical restrictions prevent returning to his or her pre-injury job. Options include finding a temporary light-duty position, reducing hours or adjusting the employee’s regular job to accommodate restrictions.

Make it clear when, where and to whom the employee is to report.

If the accommodation means the employee will be earning less pay, either because of reduced hours or the position pays less, SFM can make up some of the difference by paying temporary partial disability benefits.

Learn more about return-to-work with the post about why return-to-work matters now more than ever to your bottom line.

Bringing injured employees back to work as soon as their doctor allows it is not only the right thing to do, it’s also the smart thing to do.

A strong return-to-work program benefits your employees and your organization. Employees typically benefit from faster recovery, feeling productive, maintaining their routine, and keeping their relationships with coworkers. Employers benefit from reducing the risk of litigation and controlling future workers’ compensation premium increases.

Even when injured employees can’t return to their regular jobs right away, you can bring them back to work as soon as possible by providing modified-duty tasks or reduced hours.

Waiting periods: Your window of opportunity

Workers’ compensation claims that do not result in wage-replacement benefits (called medical-only claims) have less impact on your future premium than lost-time claims.

Whenever possible, you can help claims remain medical-only by bringing employees back to work within your state’s waiting period.

The waiting periods are:

• Three days in Iowa, Minnesota and Wisconsin
• Seven days in Nebraska, Kansas and South Dakota

To accomplish this, you may have to move quickly. It pays to be prepared.

How to establish a return-to-work program

If you don’t have a return-to-work program already, follow these four steps to start one:

1. Draft your policy.
Formally state that your company intends to bring injured employees back to work as soon as they’re medically able and will provide adaptations or light-duty work when needed. For guidance, see our sample return-to-work program.

2. Appoint a claims coordinator.
This is an individual tasked with overseeing workers’ compensation claims and return to work. Have this person develop a plan for reporting injuries and communicate it to supervisors and employees. For more details, see our CompTalk on claims coordinator duties.

3. Select a primary care clinic.
Establish a good working relationship with a local clinic where the physicians understand occupational medicine and return-to-work. If possible, meet with doctors at your preferred clinic to give them an overview of your organization and tell them you are committed to returning employees to work as soon as they are medically able. Suggest that your employees go there if they’re injured. Note that in most states, employees have the right to choose where to have their injuries treated.

4. Identify transitional jobs.
Light-duty or modified-duty jobs provide opportunities for your employees to return to work even when medical restrictions prevent them from doing their regular jobs. Put together a list of light duty jobs in advance so that you’re ready when an injury occurs. To come up with ideas, ask your managers, “What would you do if you had an extra pair of hands?” You can also find lists of light-duty job ideas broken down by industry.

How to learn more

Check out our sample return-to-work program, more details on establishing a relationship with a medical provider, and more information on how return-to-work impacts future workers’ compensation premiums.

When an employee experiences a traumatic event at work, workers’ compensation coverage is probably the last thing on your mind. But knowing how post-traumatic stress disorder is defined and covered in your state can help you make sure your employee gets needed help.

For PTSD to be covered by workers’ compensation, it must meet the criteria as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, and be diagnosed by a psychologist or psychiatrist.

By definition, symptoms must last or start a month or more after the event to be considered PTSD. Symptoms that last less than a month are considered acute stress disorder. This nuance is important when it comes to how different states handle PTSD claims.

Some states specifically address PTSD in their workers’ compensation laws. In other states, whether PTSD is covered depends on what caused it and whether the state recognizes that event as a work injury.

If the event that led to PTSD was physical, most states will recognize that as a physical/mental injury (that is, a mental injury caused by physical injury) and treatment for PTSD will be compensable. If the employee was involved in a traumatic event, but there was no physical injury, some states may not recognize PTSD as a claim. This is referred to as a mental/mental injury.

Here are the specifics on PTSD in SFM’s core states:

• Minnesota
  PTSD is specifically addressed in the statute. If an employee is diagnosed with PTSD by a licensed physician or psychologist and the employee meets the Diagnostic and Statistical Manual of Mental Disorders criteria, the claim is covered by workers’ compensation benefits. This is the only type of mental/mental claim recognized in Minnesota. If PTSD is diagnosed as arising from a physical injury, that would be compensable in Minnesota as a physical/mental claim.

  For injuries occurring after January 1, 2019, it will be a presumption that PTSD in first responders is compensable under workers’ compensation, absent preexisting history and limited statutory exceptions. PTSD claimed due to job performance issues, such as demotions and layoffs, is not compensable.

• Wisconsin
  PTSD is not specifically addressed in the statute. Mental/mental injuries can potentially be compensable if the circumstances causing the injury arise from extraordinary stress. It must be a far greater stress than the expected emotional strain that employees encounter daily without serious mental injury.
• Iowa
  Mental/mental injuries are recognized, but in order to be compensable under Iowa law, the work condition and circumstances lead­ing to the mental condition must exceed that which is typically experienced by peers in that same profession. PTSD may be compensable without any physical injury to the body under these circumstances.
• Nebraska
  Mental/mental injuries are not compensable in Nebraska, so a diagnosis of PTSD without any physical injury would typically not be covered. If there is a physical injury to the body and PTSD is a condition that is a result of that injury, it could be compensable as a physical/mental injury.

  However, first responders are an exception. PTSD could be compensable as a mental/mental injury for first responders who are exposed to extraordinary and un­usual stimuli in comparison to normal conditions of their employment. Nebraska statute defines first responders as sheriffs, deputy sheriffs, police officers, state patrol troopers, volunteer or paid firefighters, emer­­gency medical technicians and paramedics.

• South Dakota
  South Dakota does not cover mental/mental injuries. There must be a physical injury to the body. If an employee sustains a physical injury and claims PTSD as a consequential injury, then it could be compensable.

Intervene early to help employees who’ve experienced trauma

Although PTSD cannot be diagnosed until 30 days after a traumatic event, you shouldn’t wait that long to reach out to your employee. Early intervention can prevent situational anxiety from progressing to PTSD. Encourage any employee who may be susceptible to seek help through your employee assistance program, SFM’s Injured Worker and Family Assistance Program or from a psychologist or psychiatrist.

“If someone has experienced trauma, be it physical or mental, coping skills for them to be more resilient so they can manage their stress and anxiety is what’s going to get them better,” said Director of Medical Services Ceil Jung, RN, BSN, CCM. “Treatment is typically cognitive behavioral therapy (CBT). Symptoms can usually be effectively managed to restore the individual to normal functioning.”

SFM’s claims representatives spend all day managing workers’ compensation claims. They coordinate with injured workers, employers and medical providers. Many of them have decades of experience in the field. So, when we asked them to give us their top tips for employers, they delivered.

Here’s what the claims adjusters said:

• When hiring, include the physical demands of the job in the job description. Have prospective candidates sign off on the descriptions to signify that they can perform the essential functions of the job. Pre-employment physicals and criminal background checks are also important.
• Always investigate after an injury. Document how, when and where the accident occurred. Talk with the injured employee and witnesses, and take photos. If you have surveillance cameras in the area, let the claims representative know. Then figure out how to prevent it from happening again. This information also helps claims representatives to verify what they are told by the injured worker.
• When bringing employees back to work, work together with the employee to look for ways they can perform their job within their medical restrictions. Your claims representative can also provide suggestions and resources if needed. Require the employee and supervisor to commit to working within those restrictions. It’s always good to put it in writing and get everyone to sign off.
• Be sure to tell your claims representative right away when an employee starts needing time off for a work injury and when the employee returns to work so that benefit payments are on time and correct.
• Focus on building strong relationships between employees and direct supervisors.
• Continue communicating with injured employees, even if they are totally disabled and unable to return to work. Keeping the lines of communication open and letting employees know you care about them is really important.
• Address disciplinary issues with staff right away. If you don’t, and the employee is injured, these issues become much more difficult to deal with.
• If an employee is injured in a work-related automobile accident, be sure to send the claim to both your workers’ compensation and auto insurer. If the injury is work-related, workers’ compensation provides primary coverage, and your insurer will pursue recovery from an at-fault party.
• Make a copy of any paperwork an injured worker brings in, especially any doctor’s reports, and forward to the claims representative.
• Report all claims right away.
• Allow your claims representative to deliver hard-to-hear news to the injured worker versus doing it yourself. That helps you maintain a positive relationship with the employee, which is more conducive to a speedy and effective return to work.

 For more tips, read four things you need to do after an employee is injured.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Fast, accurate injury reporting can reduce frustration for everyone involved.

Sometimes it can even reduce costs by preventing:

• State penalties
• Litigation
• Delayed return-to-work
• Low employee morale
• Unnecessary medical costs

Following are some of the most common reporting mistakes we see, and ways you can easily avoid them:

• Not indicating that an employee is missing work due to a work injury.
  As soon as your employee begins losing time from work due to the injury, let your claims representative know, so the employee receives wage-replacement benefits on time. Failing to do this can lead to state penalties and financial hardship for the employee.
• Reporting late.
  As soon as any supervisor, manager or claims coordinator becomes aware of an injury, the clock starts ticking toward your state’s deadline to determine whether the employee is due workers’ compensation benefits. Missing the deadline can result in significant state penalties. Reporting right away gives your claims representative enough time to investigate the injury before the deadline. See the How to report a work injury page for details on how to report.
• Incomplete forms.
  If you choose to report your claim by filling out a form, leaving off important information can delay processing of a claim. Especially important details include: Social Security number and date of birth of the employee, date of injury, date of first day of lost time, date employer was notified about injury, and contact information.
• Communications breakdowns.
  Make sure employees and supervisors understand the process for reporting a work injury at your organization. Delays in reporting injuries sometimes occur because employees simply don’t know who to tell if they are injured.
• Including sensitive information in first reports.
  In some states, including Minnesota, the injured employee is entitled by law to receive a copy of the First Report of Injury. If you suspect fraud, or have other sensitive information about the incident, report it to your claims representative separately or report your concerns through our website. If you report through the SFM Work Injury Hotline, you can call or email your claims representative about your concerns. If you report the injury using a form, you can write it on a separate piece of paper and attach it to the first report. If you report online, you can type it in the confidential comments box on SFM’s online First Report of Injury.
• Not reporting questionable claims.
  Sometimes employers don’t report an injury because they think it is suspicious, or not serious enough to report. This is a violation of state laws, which require the employer to report any injury claimed by an employee. Instead, report all injuries, but let your claims representative know about your concerns. Your claims representative will investigate the claim and its circumstances.
• Sending a First Report of Injury to your agent.
  Please report workers’ compensation claims directly to us. Sending them to your agent can delay our receipt of the report, which can hamper our ability to investigate and respond promptly to the claim.
• Filing in the wrong state.
  For employers with multiple locations, sometimes there’s confusion over which state to file the claim in. Due to the differences in states’ workers’ compensation laws, this can sometimes be difficult to determine. A good rule of thumb is to file in the state where the employee was hired or typically works. When in doubt, it’s still best to make the report right away and let your claims representative know that you have concerns.

This post was originally published on June 18, 2013, and updated on June 15, 2021.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

By Tom Davern, Esq., Senior Defense Counsel with SFM’s in-house law firm, and Julie Bischoff, Senior Subrogation and Special Investigations Representative

When one of your employees is injured in the course and scope of employment and a negligent third party bears some responsibility, we can sometimes recover a portion or all of the workers’ compensation claim costs from the responsible party through subrogation.

Each of SFM’s core states have different workers’ compensation subrogation laws, but the basic principles are the same across the board. If a third party’s negligence causes a work injury to some significant degree, there is a possible subrogation claim. The employer and insurer have to prove negligence, causation and damages.

When we recover claim costs, it lowers the impact that the claim has on future workers’ compensation premiums by mitigating the hit to the employer’s experience modification factor (e-mod). In 2020, our Subrogation Team recovered more than $1.5 million. In many cases, SFM recovers 100% of what was paid on the claim. In fact, full recovery was received on over 50% of the subrogation claims in 2020. A complete recovery is most likely when there is no liability dispute and the injury is not serious enough to allow or motivate an employee to pursue a personal injury claim. If the employee pursues a claim for damages against the third party, it usually results in a partial recovery for the employer and insurer.

Common recovery scenarios

Motor vehicle accidents, slip-and-fall injuries and dog bites are just three types of claims where we can often make subrogation recoveries.

For example, if a pizza delivery driver is hit by a drunk driver, we may be able to recover the workers’ compensation benefits paid from the at-fault driver’s insurer.

If there is provable negligence, slip-and-fall claims can result in a subrogation recovery; however, these have to be carefully analyzed on a case-by-case basis. There is not going to be a viable claim if a slip and fall happened in a parking lot during a blizzard, but if a vendor spilled oil in a hallway and failed to clean it up, there may be a claim.

If a dog bites a home health care worker or delivery person at a customer’s home, we may be able to recover costs from the individual’s homeowners or rental insurance policy. SFM also pursues product liability claims, medical malpractice and restitution in criminal matters.

How employers can help

If you have a claim that has recovery potential, your claims representative or someone from our Subrogation Team may reach out for assistance in the investigation. It is helpful to gather and preserve any available evidence in cases that may have recovery potential.

Anytime you think a third party could be responsible for a work injury, let your claims representative know. SFM aggressively pursues recoveries on behalf of our policyholders when another party is at fault.

Common requests for subrogation claims

• Motor vehicle accident: Police report, photographs of the property damage or scene, third-party driver/insurance information, and video of the incident (if available)
• Dog bites: Name and address of the dog owner and police or incident report
• Slip, trip and fall: Photographs of the area of the fall, any available video (we also recommend reporting the incident to the property owner)
• Assault: Whether criminal charges were filed, and if so, the name of the assailant
• Product liability claims: Secure the product and provide owner manuals, maintenance records, purchase receipts and manufacturer information (for equipment malfunctions, we recommend also taking photos and keeping any broken equipment)