Workers’ compensation is a safety net for all the employees of a business. Essentially, it’s a type of medical insurance which most companies will have to offer to their in-house staff.
Most often, workers’ compensation coverage is used for medical expenses and associated ongoing care costs. However, workers’ compensation benefits also extend to lost wages and funeral expenses.
In case of a work-related injury or illness, workers’ comp comes into play. Its purpose is twofold: to provide employees with access to medical care, and to reduce employer liability. Instead of the worker suing their company for an injury expense, they resolve it with workers’ comp.
Moreover, serious injuries or illnesses will also mean lost wages because of recovery periods. This would normally lead to an argument with the affected employee.
Thankfully, workers’ comp also covers this aspect. While the specific rules can differ from one state to another, the process is mostly the same.
So, in case you’re in a business that’s spread across multiple regions, don’t worry. It’s not going to get complicated.
In fact, here at Hfit Health, we’ve been helping some of America’s top companies to resolve workers’ compensation claims for 7+ years.
Remember that most local administrations will force you to carry workers’ compensation coverage (punishable by fines, lawsuits, or even criminal charges). It’s very helpful to have trusted professionals by your side to act as mediators between all sides.
Additionally, we also have a number of clinicians that can offer occupational health services right on your premises. Contact us ASAP, and we’ll discuss all the details together.
What is Workers’ Compensation Coverage?
Workers’ compensation is a type of medical insurance. While only businesses (as a legal entity) can buy it, it applies to the employees of that business. In case of a work accident, the benefits of workers’ compensation apply to all the affected employees.
This means that injuries or illnesses will be treated by the in-network partners of your workers’ comp insurer. In the case of a major trauma though, first aid should be given on-site, while calling 911.
Once the emergency medical services stabilize the patient, you file a workers’ comp claim for further healthcare. In the case of federal institutions, the insurance is provided by the government. Each state also has their own workers’ compensation benefits program.
In many cases though, you’ll be working with a private provider. The state does regulate these insurers, but they’re free to set their own prices and pick their clients.
One important benefit of workers’ compensation for employers though is that there’d be little reason left for an employee to sue.
Similarly, keep in mind that only work-related accidents are covered. This means any injury or illness that occurs either on premise, or anywhere else an employee is (for work reasons) during normal work hours.
Getting cut is as much a work accident as it is to get into a traffic collision while transporting company goods in a truck.
What Does Worker’ Comp Cover?
Either the employer or the employee should file an insurance claim ASAP (within 24H) for any of the following scenarios:
- Medical care for injury or illnesses sustained while working.
- Lost wages/replacement income.
- Applicable to employees that can’t perform their work duties for at least 6 days because of a work injury or illness, or they can only do so in a limited capacity.
- Compensation for a permanent injury.
- Ongoing care for injuries or illnesses with a long-term recovery.
- Compensation to family members in case the worker is killed by a work accident.
- Retraining costs.
- In case an employee is no longer medically fit (even temporarily) for their previous role because of a work injury or illness.
Thing is, if you’re an employer, we believe you should consider the following: workers’ compensation benefits are usually more modest. Additionally, they tend to only account for the physical health of the affected staff.
Instead of treating the effect of a work accident, you should strive to prevent it. That’s just a core occupational health practice. If you’re interested in work injury & illness prevention, just get in touch with us.
As part of our partnership, we’ll also help you with workers’ comp claims if they arise.
Common Workers’ Comp Claims
Workers’ compensation benefits are available as soon as a work injury has occured.
Aside from the costs of the medical exam and other required medical procedures, the benefits of workers’ compensation extend to disabilities.
Exactly how much an employee would receive depends on the local laws of your state. They also factor in the type of injury or illness, and the normal wage of the worker.
- For a temporary disability – If the employee can’t perform their duties while recovering, they’ll receive about 2/3rds of their average wage. It could go higher depending on the state’s policies and its yearly finances.
- For a permanent disability – This will be a more complicated process. The sum is determined by state laws that examine the permanently injured body part, the nature of the injury and its severity.
It is possible for an employee to receive disability aid both from their workers’ compensation benefits (not taxable!), and their Social Security benefits. However, there are precise eligibility criteria that must be met. Usually, one side will provide less than they normally would.
At the same time, once the workers’ comp claim is finalized, the Social Security benefits could permanently be reduced. This offset depends directly on how the claim is settled and worded.
The most common use of a workers’ compensation coverage is to help employees with their medical expenses. In case they suffer a work-related injury or illness, workers’ comp will pay for all involved costs.
Depending on what the worker needs, the insurance could pay for emergency interventions, surgeries, hospitalization, prescription drugs, etc. However, workers’ comp is a case-by-case basis. While it may cover emergency costs, it won’t always assure a convalescence income.
For example, let’s say an office worker slips on a wet floor and sprains their ankle. The company’s workers’ compensation will probably cover their hospital visit. However, since they’re only likely to miss a few days of work at most, the insurance will likely not cover those day’s lost salary.
In order to maximize the gains of a workers’ compensation policy, we recommend working with a trusted partner like Hfit Health.
A stress injury (or repetitive injury) is a condition that develops over time. Its general characteristic is long-term pain caused by the repetitive motion of a body part over a long timeframe.
Stress injuries can mostly heal by themselves if care is provided at the first signs. For example, if an office worker constantly gets back pain after long periods of sitting down, their chair surely isn’t ergonomic. Long-term, this could develop into scoliosis (the backbone becomes curved).
Repetitive injuries most affect:
- Arms or forearms
- Hands & fingers
Almost all signs of a stress injury start off with pain. Other symptoms develop in time, such as burning, throbbing or aching. Employees could also feel tingles in their fingers, or muscle weakness.
In more advanced cases of a stress injury, muscle cramps or swelling could be present too. Even basic actions like hammering improperly can lead to feelings of electric shock and nerve damage.
Even though these injuries have a chronic nature, they’re normally covered by the benefits of workers’ compensation too. The reasoning is simple: it’s still a work injury. The problem developed because of an activity that was performed for work reasons.
Unlike traumatic events that cause severe injuries instantly, non-ergonomic work practices can take months or years to develop into health issues. All the more reasons to take preventative measures as soon as possible.
For example, finger and wrist problems aren’t common just for factory workers anymore. Even constant typing at a keyboard that lacks ergonomic considerations can cause them.
In such cases, workers’ compensation benefits are used to cover the costs of ongoing treatment.
A lot of industrial workspaces will have harmful chemicals or allergens that can cause illnesses. For example, workers that are constantly inhaling the chemicals given off by paint will develop lung problems if they’re not provided with respirators.
Other times, long-term exposures to allergens will actually cause the employee to develop an allergy. This could manifest as sneezing, a stuffy nose, watery eyes, contact dermatitis, etc.
Workers’ compensation coverage also extends to these chronic conditions (treatment, ongoing care, etc). Of course, each claim can cause an increasing premium rate which the company must pay.
In order to avoid paying too much for this insurance, we advise a professional ergonomic assessment. By determining ahead of time which activities present health risks, you can take action to minimize them.
Some work-caused injuries and illnesses are worse than others. If the effect of an accident can’t be solved in a single treatment, workers’ comp can also be used to cover ongoing care.
This could mean hospitalization, physical therapy, or anything else that physicians deem appropriate. You should always make it a priority to discuss the possibilities with an injured worker, before they consider suing you for way more.
However, remember that employees aren’t always free to choose whoever or wherever for their ongoing care. Insurance providers have preferred hospitals, doctors, and treatment options.
As a better alternative, you should contract an occupational health provider like us. Our clinicians handle examinations, health risk assessments, emergency interventions and long-term care.
If an employee can no longer earn their working wages because of a work accident, the insurance will help keep them afloat. While workers’ comp won’t account for the entirety of the lost income, it’ll still grant the recovering employee a stable sum to rely on.
Additionally, workers’ comp helps even if recovering staff are still able to work in a limited capacity. In case workers are forced to earn less by taking lower paying jobs or fewer hours while getting better, they’ll be assisted by insurance.
What they receive in this case will vary based on the scenario. For example, temporary totally incapacitated employees are given 60% of their gross average weekly wage from the year before their injury date. Those benefits can then last for 156 weeks.
However, a partially incapacitated employee (who continues working) will receive different workers’ compensation benefits. Namely, 75% of their weekly temporary benefits.
- Example: if an employee receives $235 a week as total temporary benefits, their maximum workers’ comp benefits would be an additional $176.
Funeral Costs & Spouse Help
In case a work accident takes the life of an employee, workers’ compensation coverage extends to funeral expenses. Aside from helping the family of the deceased cover the last rites, workers’ comp will also provide death benefits to the affected family.
Spouses are eligible for the death benefits as long as they don’t remarry, and remain dependent on it. All of the deceased employees’ children are eligible while being under 18 years old.
However, children can also be eligible if they’re full-time students, or can’t work because of a physical or psychological disability.
In a spouse’s case, they’d receive 66% of the weekly wage of the deceased, which could be increased to the maximum state average at the time of their death.
Moreover, 2 years after the death of their spouse, the remaining partner becomes eligible for a cost-of-living-adjustment. However, this right will be lost in case of remarrying, along with the other workers’ compensation benefits.
Still, even if the spouse remarries, all eligible, dependent children will receive $60 a week. If there are many children though, note that the total amount is not allowed to go over the weekly wage of the deceased parent.
If a worker suffers a severe trauma (such as losing a limb) and can no longer work, insurance will help cover their treatment and supplement a portion of missed wages. These benefits will aid the disabled employee in continuing to live their life more decently.
At the time of the injury, the minimum an employee can collect on is 20% of the state average weekly wage. However, down the line, they should continue to receive 66% of their avg. gross weekly wage.
Lastly, permanently disabled employees will receive annual cost-of-living-adjustments. All of these workers’ compensation benefits continue for as long as they’re disabled.
Does Workers’ Comp Cover Long-term Injuries?
Yes, workers’ compensation coverage is available for temporary or permanent disability too. While workers’ comp is generally thought of as a safety net for incidental accidents, it also supports chronic conditions.
Whether an acute injury or illness has worsened into a chronic state, or a work-induced health problem forms over a long period of time, workers’ comp covers them.
For example, lifting heavy crates day in and day out will probably cause elbow pain. This is the first sign of inflammation, which can develop into more serious tendon damage. Such conditions require long-term treatments, for which employees can claim workers’ compensation.
The Workers’ Compensation Claim Process
It’s important to start the claim process as soon as work-related injury or illness happens. Try to set your target for at most a 24H timeframe. The first step is to be aware of your state’s legislation ahead of time. The procedure differs from state to state.
You should add these following points to your company’s workers’ comp claims SOP:
- The injured employee(s) must receive medical attention immediately. From a trained supervisor or HR, from OccHealth clinicians, or from whoever else is qualified enough to offer first aid.
- Right after a work accident, you should check with all the employees in the affected area. See if any of them were injured, so you can start the claim process if needed.
- Your insurer must be notified that you have a claim to submit. In some cases, you’ll also need to inform the state’s workers’ comp representatives.
- The insurance company has the final say about which workers’ compensation benefits will be approved or denied. Once the claim review is completed, the employee(s) will receive whatever the insurer has approved internally.
- In-between talks with the insurer, you must also report the accident to OSHA if it caused a severe injury. Severe means the loss of senses, limbs, or any event that requires hospitalization. You only have 1 day to submit this report, and only 8 hours if a death occured!
- Empower open communication with the injured employee(s). As an employer, you should take steps to assure them that you’re doing everything you can to look after their health. This’ll help keep morale high.
While it’s best to act fast and submit your claim, you usually have between 30 and 90 days. In case you go over this time limit, the insurance company could reserve their contractual right to ignore it.
Workers’ Comp Rights for Employees
While workers’ compensation coverage is an alternative to lawsuits, some states still allow suing for reckless or intentional endangerment. In some areas, it’s also possible to forward a lawsuit for wrongful deaths, even if there’s workers’ comp in place to help cover the costs.
The thing is, employees will almost always waive their right to this insurance once the lawsuit begins. But, if they’re successful, the court will probably determine a whole list of damages that the employer will be held accountable for.
In order to avoid this drawn-out legal process, you should partner with us at Hfit Health. Our occupational health specialists will act as neutral negotiators, so that both sides stand to be satisfied without involving lawyers.
- Remember – most states prohibit firing an employee for filing a workers’ comp claim. Retaliation from employers can be reported to the local workers’ comp state office, which will begin an investigation.
What if The Workers’ Comp Claim is Denied?
Sometimes, workers’ compensation claims are denied. If that’s the case, a letter is usually issued which will explain why approval wasn’t possible. Within the letter, there’d also be details about how to make an appeal.
In case the insurer provides no information about how to make an appeal, check the website of your state’s workers’ comp agency. The steps should be outlined there.
Keep in mind that appeals have a deadline. Read the “fine print” carefully, because you can’t circumvent the rules. Act promptly, and you might be able to fight the reasons for the denial.
Who Is Covered by Workers’ Comp?
Workers’ compensation benefits aren’t actually required in all cases. Depending on the specific role for which an organization is hiring, this insurance might not be part of the deal. Similarly, the necessity of workers’ comp also depends on the size of the business.
While the general guidelines of workers’ compensation coverage are nation-wide, specific rules can depend on a state-by-state basis.
Still, most states are going to demand that employers have workers’ comp for their full-time staff. In cases where there are fewer than 3 – 5 full-time employees, the law can differ. You should check your local law for minimum amount of workers if your business is in:
- New Mexico
- Rhode Island
- South Carolina
- North Carolina
The law for workers’ compensation benefits also differs when it comes to temporary staff, interns and contractors. Depending on the location of the company, these categories of employees might not have access to workers’ comp.
Federal employees are another special case. They are covered by the federal workers’ compensation insurance program, and so are exempt from others.
Who Isn’t Covered by Workers’ Comp?
While workers’ compensation benefits were designed to help anyone that’s suffered a work injury or illness, there are limits. The list of covered events is pretty large, but there are terms & conditions that apply to an employee’s rights.
For example, before offering workers’ compensation coverage for an injury, the insurance company will have staff screened for alcohol or drug use. If it’s proven that they were under the influence when the injury occured, the claim is denied.
Similarly, insurance companies are going to deny any work injury claim if:
- The injuries were self-inflicted by the employee.
- The accident wasn’t connected to a work activity.
- The accident happened because the worker broke the law in some way.
Furthermore, workers’ compensation benefits don’t have to be given to all types of employees. Not from a legal standpoint anyway (employers can still choose to do so).
For example, some states don’t force businesses to offer the insurance to:
- Casual workers – part-time, contingent work, paid on a piece work basis.
- Domestic workers – employees whose duties are within a residence; cleaners, cooks, butlers, nannies, etc.
- Contractors – externally contracted workers for finite timeframes and clear tasks.
- Farmhands – any agricultural worker involved in sowing crops, tending to them and harvesting them. However, from a labor law perspective, some states consider workers hired for other farm activities (such as picking fruit) not to be farmhands. Similarly, one state might mandate workers’ comp for any farm with 3+ full time employees (Virginia), while another’s law can make it mandatory only for 6+ (Florida).
- Day laborers & seasonal workers – Seasonal workers have fixed contracts depending on the weather. Day laborers only get paid 1 day at a time without the promise of future work.
- Insurance agents
- Real estate agents
- Business owners & business partners
- Railroad employees
- Maritime employees
The Benefits of Workers’ Compensation
Workers’ compensation is a two-way street. States force most employers to offer it for their employees’ wellbeing, but it actually benefits businesses too.
Without workers’ comp, any job injury or illness can result in a lawsuit. That’s a long, tiresome and drawn-out process for everyone involved. Instead, with workers’ comp, the employee is happy that they have a healthcare safety net, and the employer has another benefit to offer.
Moreover, workers’ comp also does wonders for morale, especially in dangerous fields. For example, construction workers would be less likely to agree to work on scaffolding, if they knew they have no health insurance from their employer.
Workers’ compensation coverage is to everyone’s best interest.
To get the most out of your policy as an employer, we highly advise collaborating with workers’ compensation experts like us (Hfit). We have the experience and the expertise to smooth out and expedite the process.
Workers’ Compensation Benefits (Employers)
- Employee treatment plans for work injuries & illnesses.
- Improved worker morale and company loyalty.
- Drastically reduced lawsuits for work accidents.
- Compliance to state laws and OSHA regulations about workers’ comp.
- Support for your employees while recovering (nothing else needed from you).
- Lost wages recovery for employees (hurt employees aren’t a financial burden to you).
Workers’ Compensation Benefits (Employees)
- Partial incapacity benefits.
- Total incapacity benefits.
- Medical benefits.
- Appropriate care & treatment.
- Gas reimbursement for traveling to and from medical visits.
- Prescription reimbursement.
- The right to choose your own health care providers after the first visit to another specialist (which is chosen by the employer).
- Regular health evaluations after a job injury or illness.
- In case the insurer considers treatment is no longer reasonable and denies further payments, employees can appeal the denial.
- Issued insurance card with attached claim number (used for billing the insurer directly and requesting treatment pre-approval).
- Permanent disability and/or scarring benefits.
- Death care benefits (funeral and family financial support).
- Vocational rehabilitation (work skills retraining for people with permanent functional limitations).
We’ll Help You Handle Workers’ Compensation
Workers’ compensation benefits can feel like a lot to handle. And, they can be, unless you work with our vetted professionals. At Hfit Health, we have a combined experience of 50+ years in everything even remotely connected to occupational health.
As workers’ comp is such a core business aspect, you should always collaborate only with the best experts available. Well, that’s us!
The moment we become partners, we can set up an on-site clinic on your premises. From there, we’ll ensure your employee’s well being with a multi-faceted approach:
- Simple worker’s compensation.
- Safety inspections.
- Employee lifestyle improvements & better morale.
- Fewer expenses.
- Legal compliance.
- Fewer medical leaves.
- Medical surveillance & telehealth.
- Regular health screenings.
- Ergonomic assessments & improvements.
- Risk prevention & emergency first response.
- Illness evaluations.
- X-ray services.
Additionally, our urgent care workers’ comp offer includes:
- Company legal liability protection.
- Reduced workers’ compensation costs.
- Efficient workers’ comp negotiation & mediation.
- Up-to-date knowledge of local legislations and government safety measures.
- Top-shelf proprietary technology for impeccable clinical care.
- Appropriate & cost-effective care.
- Patient-centered treatment plans.
- Fast access to medical professionals and a proven promise of short wait times.
- Innovative solutions to solving your organization’s health challenges (including prevention).
Contact us today to start your occupational health improvements!