Following an on-the-job injury or work-related illness, there\u2019s a limited amount of time to report the incident and file a workers’ compensation claim. Failure to do so could result in a denial of workers\u2019 compensation insurance benefits.<\/p>
That\u2019s why employers must train their employees to immediately report an injury at work. As the employer, you\u2019re typically responsible for submitting a claim to your workers\u2019 compensation insurer, but you\u2019ll first need to gather details and documentation about the incident.<\/p>
Workers\u2019 compensation insurance provides coverage for employees who suffer work-related injuries or illnesses. It covers medical expenses, disability benefits, and lost wages for employees who are injured or become ill while performing their job duties. Most workers\u2019 compensation programs are paid for by private insurers, from premiums paid by the individual employers. Each state has a Workers\u2019 Compensation Board, a state agency that oversees the program and intervenes in disputes.<\/p>
There are federal workers\u2019 compensation programs that cover federal employees, longshore and harbor workers, and energy employees. Another federal program, the Black Lung Program, handles death and disability benefits for coal miners and their dependents.<\/p>
To protect your staff, workers\u2019 compensation insurance is essential and is even a legal requirement in most states. It provides financial support and medical benefits to employees who are injured or who become sick due to their employment. In addition, it prevents you from paying costly expenses.<\/p>
Workers\u2019 compensation, commonly referred to as \u201cworkers\u2019 comp,\u201d is a government-mandated insurance program that provides benefits to workers who become injured or ill on the job or as a result of the job. It is effectively a disability insurance program for workers, providing cash benefits, healthcare benefits, or both to workers who suffer injury or illness as a direct result of their jobs.<\/p>
It is your responsibility as a business owner to provide a safe work environment for your employees, but accidents and injuries may still happen. <\/p>
The lack of federal standards for workers\u2019 compensation has resulted in extremely varied policies for the same kinds of injuries from state to state.<\/p>
Identical injuries can receive radically different kinds of compensation depending on where a worker resides. A paper by the Occupational Safety and Health Administration (OSHA) flatly calls workers\u2019 compensation a \u201cbroken system,\u201d and estimates that 50% of the costs of workplace injury and illness are borne by the individuals who suffer them. Low-wage and immigrant workers often don\u2019t even apply for benefits.<\/p>
There are two types of workers\u2019 compensation coverage: Coverage A and Coverage B.<\/p>
Workers who accept workers\u2019 compensation generally waive the right to sue their employers, agreeing to a no-fault contract in doing so. However, state legislation and court rulings in a number of states have restored the employees\u2019 right to sue in various strictly defined circumstances.<\/p>
Thus, an employer may opt to purchase a policy that combines Coverage A and Coverage B.<\/p>
While the workers\u2019 compensation claims process can seem complicated, it can be broken down into five basic steps.<\/p>
As an employer, make sure your employees know that if they become ill or injured on the job, they need to inform you as soon as they are able.<\/p>
Typically an injured employee is required to provide written notice, and most states set deadlines for reporting injuries. For example,\u00a0the employer must be notified within 30 days\u00a0in New York, while other states allow employees a year or more to report an injury.<\/p>
A variety of injuries may qualify, such as slipping on a wet floor in the office and breaking an arm, or developing carpal tunnel syndrome from repetitive typing.<\/p>
Some injuries may require immediate treatment at an emergency room or urgent care facility. Others may require a doctor\u2019s visit for diagnosis and medical care. Depending on the state and the insurer, the employee may need to seek non-emergency treatment from a medical provider that\u2019s part of the insurer\u2019s network to receive benefits.<\/p>
With injuries or illnesses that surface over time, such as mesothelioma (caused by exposure to asbestos), the employee should report the illness as soon as possible.<\/p>
Once you\u2019ve been notified of an employee injury, you\u2019ll need to provide your injured worker with information on their rights and\u00a0workers\u2019 comp benefits, as well as their return to work.<\/p>
In most states, you\u2019ll give your employee a workers\u2019 comp claim form to fill out and return to you. This form will detail the nature of their injury, along with where, when, and how it occurred. You may also need to have your injured employee fill out a first report of injury form that you\u2019ll submit to your state\u2019s workers\u2019 compensation board.<\/p>
Which forms are required and who is responsible for completing them depends on the state where you and your employee are based, the type of illness or injury, and the insurer.<\/p>
It\u2019s a good business practice to include workers’ comp insurance information in your new hire employment packet to ensure your employees know their rights if they\u2019re injured on the job. If you fail to provide this information, you could face a lawsuit.<\/p>
Usually, the employer is responsible for sending the claim form and all supporting documentation to the workers\u2019 comp insurance carrier, but the employee\u2019s doctor will also need to submit a medical report.<\/p>
Additionally, you may be required to report the injury to your state’s division of workers’ compensation or workers’ comp board. This may apply to all workplace injuries, even if your employee is not seeking workers\u2019 comp benefits.<\/p>
How long does an employer have to file a workers’ comp claim? Typically, the employer has seven days to submit the claim to all necessary parties, including the insurer. This window can vary by state, so it\u2019s important to check your state\u2019s laws.<\/p>
Once the claim is filed, the insurer will either approve or deny the claim.<\/p>
If a claim is approved:<\/strong><\/p> Once a claim is approved, the insurer will inform the employer and contact the employee with payment details. At this point, the employee and their workers\u2019 compensation lawyer (if any) may:<\/p> If a claim is denied:<\/strong><\/p> If your workers\u2019 comp insurer denies benefits, the employee has the option to:<\/p> How do I know if my workers\u2019 comp claim is approved?<\/strong><\/p> Within a few weeks, you should receive a written notice of the outcome of your claim: approved or denied. If you haven\u2019t heard from the insurance carrier handling your workers\u2019 compensation case, contact the insurance adjuster or claims administrator directly.<\/p> Once an employee has recovered from an injury and can return to work, they\u2019re required to provide written notice to both their employer and the insurance provider. Depending on the severity of the injury, the insurance company may have to pay permanent disability benefits.<\/p> Many employers choose to implement a formal return to work program, aimed at getting workers back to work and productive as quickly as possible. These programs may involve offering an injured worker modified duties, or training employees on other skills if they\u2019re unable to resume their regular responsibilities.<\/p> An employee\u2019s injury or illness likely qualifies for\u00a0workers\u2019 compensation benefits\u00a0and can file claims if it occurred on the job or within the scope of employment. This includes occupational illnesses or occupational diseases caused by exposure to harmful chemicals or other hazards while on the job.<\/p> In order to file workers’ compensation claims, all of the following must be true:<\/p> Medical expenses<\/strong>\u00a0including hospital visits, medications, and emergency surgeries are all covered by workers\u2019 compensation.<\/p> Workers\u2019 comp benefits are paid no matter who was at fault. And workers\u2019 compensation laws typically prevent employees from\u00a0suing their employers for a work-related injury\u00a0or illness.<\/p> Employees are covered for workers\u2019 compensation regardless of the number of hours they work.<\/p> However, there are exclusions, which could result in a denied workers\u2019 comp claim, including:<\/p> It\u2019s important to learn your state\u2019s workers\u2019 compensation laws and follow their requirements regarding the workers\u2019 compensation process. Failure to do so may result in\u00a0costly fines and penalties.<\/p> In addition to keeping an active workers\u2019 compensation insurance policy, make sure you:<\/p> If you need workers\u2019 comp coverage for your employees,\u00a0compare quotes online\u00a0to avoid penalties and business risks. Most small businesses can get workers\u2019 comp coverage in 24 hours, depending on the state.<\/p>The employee returns to work<\/strong><\/h3>
When should you file workers\u2019 compensation claims?<\/strong><\/h2>
What does Workers\u2019 compensation insurance cover?<\/strong><\/h2>
What does workers\u2019 compensation insurance not cover?<\/strong><\/h2>
Why business owners should follow the workers\u2019 compensation claims processes<\/strong><\/h2>
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References<\/strong><\/span><\/h2>