August 20 2019 - Did you slip and fall on the job? Do you have an employee who was hurt by a company machine?
Whether you're the employee who was hurt, the employer who is now dealing with it, or the HR person who gets asked all the questions, you need to know the details of workers compensation.
Don't know all the details and wondering how to answer workers comp questions? Good news: here we have the eight most commonly asked questions with their ideal answers. Keep reading to learn more!
1. What Is "Workers Compensation"?
Back in the day, coal miners spent their days deep underground in hazardous conditions. They often contracted diseases and died because of the nature of their work and work environment. Back then, programs didn't exist to compensate them.
Now, because of past situations like that, the U.S. government requires every employer to have insurance specifically to compensate their workers. The insurance is used in the event that a worker gets injured or sick on the job. This is workers compensation.
That doesn't necessarily cover every injury, every sickness, and every development. There are limits, restrictions, and guidelines to what is covered and how it's covered.
2. What Exactly Does Workers Compensation Insurance Cover?
Workers Compensation is supposed to cover the medical visits and treatments needed to get the employee back to work. That can include the following:
- Specialist visits
- General physician visits
- Medical treatments (like physical therapy)
- Prescribed medication
Workers comp also includes wage reimbursement. It's not fair to have to miss work because of a work-related injury and not get paid for days, weeks, even months, right? We'll go over those details a little later.
3. What If My Workers Comp Claim Is Denied?
If your workers comp claim gets denied, don't worry--it's not the end of the road. You can always appeal the denial!
The appeals process requires more time, more information, and a lot of push on your part. But it can be worth it if you believe you have a valid claim.
Another option is to sue your employer, but that is entirely separate from the workers comp program. By suing, you give up your rights to workers comp. Your employer can put that money toward their own legal fees and defense.
If you're interested in suing your employer, consider contacting a workers comp attorney. They'll help you thoroughly understand your case and whether you have a valid claim.
4. Can I Choose the Medical Provider?
When you are receiving workers comp, you must meet with medical providers approved by the workers comp insurance company. That might include your own doctor anyway, but there's no guarantee.
If you don't agree with the chosen doctor's diagnosis and ruling, you can always seek a second opinion. A second opinion can come from a doctor of your choosing. The cost, however, will most likely be left entirely to you.
5. What If My Work Injury Was My Fault?
An accident doesn't necessarily have to be faultless in order to be covered by workers comp. In fact, you can be at fault--whether by mistake or negligence--in your own injury and still be covered.
Of course, there are some exceptions. If the injury happened because you were breaking the rules or committing a crime, it probably won't be covered.
If it occurred while you were under the influence of alcohol or drugs, your claim may be denied. If you purposely caused the injury, you won't be covered. These regulations are in place to protect employers.
If you're an employer looking for workers comp insurance, click here for more information.
6. Is There a Deadline for Filing?
YES! There are always set, strict, regulated deadlines for filing claims, including workers comp. Here's the order of things you should follow after you're injured:
- Seek immediate medical attention
- Notify your employer (this doesn't count as filing the claim!)
- Check your state's claim deadlines
- File your claim with your local Workers Compensation office using the forms from your employer
Don't wait to check your state's deadlines and file your claim! If you miss the deadline, you may disqualify yourself from workers comp eligibility.
7. What Is Wage Replacement and How Is It Calculated?
Wage replacement is your employer's responsibility to reimburse you for the wages you miss out on while you're out of work. The insurance company is responsible for calculating your missed wages. They usually base the calculation on the amount you made in the 52 weeks preceding your injury.
That being said, you shouldn't totally entrust this calculation solely to the insurance company! Do the calculation yourself and work with your employer and your HR representative.
Also, make sure to be in the loop with the numbers the insurance company is working with. You are entitled to have access to the documents, forms, and numbers they use for their calculations.
8. What If My Return-to-Work Date Is Earlier Than I Think It Should Be?
After you meet with the approved medical provider, he or she will give you a date when you're okay to return to work. Usually, that comes with specific instructions like no heavy lifting or sitting work only for a specified amount of time.
If you have a valid claim, a legitimate injury or sickness, and approved workers comp, you shouldn't have to return to work before you're ready. Speak only with your doctor and your employer.
If you still run into problems or resistance, don't hesitate to talk to a workers comp lawyer. They can help you get the information and back-up you need to defend yourself.
Workers Comp Questions Don't Have to Stump You
There are many workers comp questions out there. Only a workers comp or personal injury lawyer (or an extremely experienced HR representative) might know the details of every single one.
But you can know the top eight most frequently asked worker's comp questions. You can also have the answers!
Check out our other articles about human resource management. The more you know, the better!
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