Blog - Tag: Workers’ Comp

The “Monday morning surprise” — the term for when an employee approaches you on the first morning of the working week to report an injury he or she sustained at work on Friday — can be a dreaded situation for an employer.

Nearly all organizations face this at some point and the injury report is likely to trigger an agonizing chain of events, according to a report by the Society of Human Resource Management.

The Monday morning surprise comes with several questions. Is the injury truly work-related?

Could it be a case of cumulative effects? Was this an injury sustained over the weekend, on the employee’s personal time? Do you have evidence to prove it?

The injury could be legitimate (especially if it involves the musculoskeletal system) or due to cumulative exposure, but employers should be wary of instances where an employee clocks out of a shift on Friday with no reported injury and returns on Monday with an injury.

That’s a red flag for workers’ comp fraud.

What not to do

Workers’ compensation fraud experts recommend that you do not:

• Spy on employees — If the employer plays investigator and creates a Big Brother atmosphere of spying on workers, especially when they’re injured, a huge divide in trust is created between employees and managers. When a supervisor functions as a spy, employees are quick to notice and feel devalued.
• Have employees sign a no-injury pledge — While the intent may be positive, to eliminate work-related injuries and illnesses, such an agreement discourages early reporting and could deter a worker from reporting an actual injury that gets worse over time.
• Restrict employees’ personal activities — The range of activities outside of work that could be deemed too risky for employees is impossible to define, and is not legally defensible. An employer who tries to dictate employees’ personal lives will end up with disgruntled workers.

What you can do

First you should put a policy in place that all workplace injuries should be reported to management on the day they occur. That way, the employer can investigate immediately and talk to other staff that may have witnessed the event.

The more time that goes by, the less likely that witnesses will remember anything pertinent to the claim investigation.

As you gather the facts on your injured worker, be sure to address how and when the injury occurred. Did they cite a very specific incident, or was it a gradual onset that worsened over time? If it was gradual, how long ago did the symptoms start? Did the pain stay in the same location, or is it moving around into extremities? Is it worse now after some rest or is it feeling better?

You should ask the employee why they are only reporting it on Monday, instead of Friday when the injury occurred. Often it could be an honest mistake.

Perhaps they told a supervisor who didn’t kick the information to management. Or perhaps they didn’t report it because they didn’t want to go a clinic and thought they’d feel better after the weekend.

But the biggest violation may not be the employee’s fault, it could be yours. If they did not know they were supposed to tell you about a near-miss or incident-only injury, that’s due to poor communication on your part. Workers need to know that should any incident happen, they are required to report it.

End-of-week employee injury statement

One way to address the Monday morning surprise is to develop an “End-of-Week Employee Injury Statement.”

Your accounting department can attach something like the following statement to each employee’s paycheck:

I have not received or witnessed any injury during the course of this week’s work with [Employer Name Here.]

Employees would be required to complete the form, sign it and return it to their supervisor.

The benefits of such a reporting program include:

• Employees reporting workplace injuries in a timely manner.
• Improved management-worker communications.
• Strengthened accident prevention and employee safety.
• The ability to reconcile injuries that have occurred and to alert supervisors and management of hazardous conditions and unreported injuries.
• The identification of witnesses who should be interviewed during accident investigations.

It should be noted, however, that the use of an end-of-week statement would not be defensible against a claim for benefits at the Workers’ Compensation Appeals Board, but it could be used to establish the condition of the employee leading up to the at-work injury.

California Insurance Commissioner Ricardo Lara has ordered an 8.7% average advisory pure premium rate hike for policies incepting on or after Sept. 1, 2025.

The rate follows a substantial uptick in claims and claims adjustment costs over the past four years, resulting in a $1.3 billion underwriting loss for the industry in 2024, the first since 2014. However the market is still competitive and carriers and carriers may price their policies as they see fit.

The 8.7% increase is an average across nearly 500 class codes, and according to the Workers’ Compensation Insurance Rating Bureau (WCIRB), employers in several industries may see premiums begin to rise after hitting a 10-year low last year.

The pure premium rate is a benchmark insurers use to price policies. It only accounts for the cost of claims and adjusting those claims, not expenses such as office operations, personnel costs outside of claims representatives, marketing or other overhead.

What’s driving costs

The main drivers of the rate increase, according to the California Department of Insurance and the WCIRB — which had recommended an 11.2% hike — include:

Rising medical costs. The average medical cost per claim has been steadily climbing since 2016, and reached $36,488 in 2024, up 9% from $33,573 the year prior and 28% from $28,500 in 2016. These costs are for claims that include wage replacement payouts and medical costs, meaning the injured worker was unable to work for a period of time.

Rising costs for medical-legal reports. These are prepared by a qualified physician to assess an injured worker’s condition and its relationship to their workplace injury. This report is crucial for determining eligibility for benefits. As medical costs have increased, there has been a corresponding increase in requests for these reports, which adds to the cost of a claim.

Growing effects of cumulative trauma claims. These are injuries that develop over time, typically from repetitive motions. There is an entire industry in Southern California that helps injured workers file these types of claims, which are growing significantly in frequency. The WCIRB now estimates that over one-fifth of indemnity claims involve cumulative trauma.

Rising claims adjusting costs. The average cost of adjusting workers’ comp claims that include indemnity payouts rose to $12,600 in 2024 from $9,800 in 2021, an increase of 28%. The Rating Bureau projects it will reach $14,300 in 2027.

The effects

The premium an employer pays depends on their claims experience.

According to WCIRB, more than 280 classes are projected to face a higher-than-average pure premium increase next year. Conversely, some sectors will see lower pure premium hikes, while others may see decreases.

But thanks to a robust workers’ comp market, employers with strong safety records and low X-Mods are likely to continue receiving favorable pricing.