15 Facts to Know about Workers’ Compensation Insurance

15 Facts to Know about Workers’ Compensation Insurance There are important facts you need to know about workers’ compensation insurance.

Medical review companies play a vital role in workers’ compensation cases.

Workers’ compensation is an insurance program that is designed to protect employees who get hurt or sick while on the job. Since medical records are indispensable to provide evidence regarding the injury/illness, medical record retrieval services also become highly significant. Workers’ compensation comprises five basic benefits – medical care, permanent disability benefits for workers who cannot return to work, temporary disability benefits to compensate for lost wages while the injured worker is recovering, supplemental job displacement benefits provided for skill enhancement or retraining for an injured worker who cannot return to the job he/she had before the injury, and death benefits to a spouse, children or dependents if the worker dies as a result of the job-related injury or illness.

The first comprehensive law related to workers’ compensation was passed more than a century ago, and since then the legislation has changed considerably, varying from one U.S state to another. There are also differences between state and federal workers’ compensation laws. Overall, workers’ compensation claims can be rather complex. Here is a look at some interesting and important facts about current workers’ compensation laws.

1. Workers’ compensation program mandated by the state is based completely on the number of employees at the workplace and the type of industry to which the business belongs. For example, California requires workers’ compensation insurance for all employers and work situations whereas

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Georgia workers’ compensation requires this program if there are more than 3 workers at any workplace.

2. Workers’ compensation, unlike personal injury claims, does not provide coverage for pain and suffering. It covers medical expenses, lost wages and financial support for disabilities.

3. A worker choosing to sue the employer after sustaining an injury at the workplace must first waive his/her right to workers’ compensation benefits.

4. A person collecting workers’ compensation benefits must give up the right to file a lawsuit. A third-party who was at-fault can have a personal injury suit filed against them.

5. An employee returning to work after the injury may be able to receive benefits. Continued benefits may be paid in situations such as permanent partial disability, and if the worker is making less than his/her before-injury wages.

6. Workers’ compensation benefits are mostly non-taxable. This includes payments to survivors after a fatal accident.

7. An injured worker can be paid workers’ compensation and social security at the same time. However, the social security benefits may be reduced or taxed.

8. There may be instances when an injured worker could be awarded workers’ compensation benefits even if the injury didn’t occur at the physical workspace. This is when the injury occurs within the scope of employment, which includes running errands at the request of the employer or attending an event sponsored by the employer.

9. Private insurance companies pay the workers’ compensation benefits.

Workers’ compensation benefits are actually handled by an adjuster from the private insurance company. Some workers’ compensation laws may be uniform across various states and on the federal level, but others may differ from one state to another. Employees must talk to their employers about the specific laws applicable in their own states.

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10. Workers’ compensation is necessary in every U.S. state except Texas.

Employers who don’t obtain workers’ compensation could face stiff penalties.

It can even lead to criminal non-compliance issues in California, Michigan, Massachusetts, Pennsylvania, and Illinois.

11. The cost of workers’ compensation varies from state to state. It also depends on the type of work the employee does, with higher costs for riskier jobs.

12. Employers are obligated to inform the workers’ compensation insurance carrier if an employee has not been able to work for three days due to an injury. If a claim has not yet been filed, they must continue to pay the employee, provide a written statement to the employee explaining any additional information they may need for a claim, provide a written explanation if the benefits are denied, and file an Employer’s First Report Of Injury with the state workers’ compensation commission. These requirements may also vary from state to state.

13. Some U.S. states like California are “no-fault” states, meaning injured employees don’t have to prove that their injury was the fault of someone else to receive benefits. There are also “fault” states where the employee has to prove someone else was to blame for the accident.

14. Workers’ compensation insurance is different for different industries based on unique exposures and structures characteristic of each.

15. Workers’ compensation is different from group health insurance, the former is state-regulated coverage for workers who are injured or taken ill on the job.

The latter is coverage for workers for preventative care and medical expenses for injuries/illnesses stemming from workplace activities. Most health insurance providers exclude coverage for illnesses covered by workers’ compensation.

It is important for employers and employees to understand the workers’ compensation requirements for their particular states. A workers’ compensation attorney is the best person to approach for a clear understanding of the claims

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process. Attorneys stay well-informed about the particular injury or illness and all related medical facts with the support of experienced medical review companies.

They will be able to guide claimants regarding the legality of the claim and give appropriate counsel to employers as regards obtaining a suitable coverage plan.

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