10 Important Facts about Workers’ Compensation Insurance

Workers’ compensation benefits are paid by employers to employees who are injured or become ill on the job. Workers receive benefits and medical care based on the review of their medical records. Medical evidence is the most important requirement to prove the injury or illness and medical review companies have a major role to play in assisting workers’ compensation attorneys in this regard. With a good workers’ compensation program in place, employers don’t have to worry about getting sued by their employees in the event of a workplace injury or illness.

U.S states have laws that require employers to provide their workers with workers’ compensation benefits. In the vast majority of states, except Texas, workers’ compensation coverage is mandatory. However, even if it is not mandatory, it is best for employers to participate in a workers’ compensation program and thereby protect their employees as well as their businesses. Now let us look at some important workers’ compensation facts for employers to know.

1. Workers’ compensation insurance cost varies based on industry and provider. For example, high-risk jobs such as construction and roofing carry higher premiums compared to standard office jobs. Another thing to note is that based on the number of claims filed, the company’s/employer’s premium could increase or decrease.
2. The workers’ compensation system is administered by a state agency in each stare.
3. Employees can be paid for a workplace injury even if it was partially their fault. It’s true that workers cannot purposefully injure themselves and collect benefits. However, if the injury is within the scope of their job or rises out of it, they are likely to be covered even if they were careless. But an employee who gets injured while under the influence of drugs or alcohol may not be eligible for workers’ compensation benefits. Other instances when a workplace injury is not covered include physical attack by a coworker for some personal reason; injury sustained while or as a result of breaking the law; and injury sustained while commuting to and from work. However, an employee injured while traveling as part of the performance of his/her job duties may be covered.
4. There are work-associated injuries that may occur over a period of time such as carpal tunnel syndrome and back pain that are repetitive motion-related injuries. Such injuries may be covered under workers’ compensation. It is the responsibility of employers to ensure that employees are not constantly performing such tasks. Employers should also ensure that workers are using the right tools and equipment that are also placed optimally, catering to the employee’s physical requirements.
5. In some U.S. states such as Pennsylvania, both full-time and part-time workers are covered under workers’ compensation.
6. Time limits are applicable as regards a workers’ compensation claim. Employees are required to report the injury or medical condition to the employer as early as possible. Their report should state where and when the injury occurred, the type of injury, and other relevant details. Each state has a specific number of days within which a workplace injury or illness must be reported.
7. Employees have the right to choose their own doctor if they are hurt at work. They also have the right to get a second opinion.
8. Employees covered under workers’ compensation are defined by law. The term "employees" does not generally include independent contractors.
9. Though employees do not have the right to sue the employer for a workplace injury, they retain the right to sue negligent third parties. If a third party’s negligence caused the accident and injury, the employee can sue the third party. Any compensation or proceeds from that lawsuit should be first used to reimburse the employer for any benefits paid to the injured employee.
10. Workers’ compensation is generally paid in addition to the employee’s sick pay. Employees taking time off work consequent to a work injury can use their sick time till they receive their workers’ compensation benefits. Employees must notify their employers in writing that they are using their sick time to recover from the work-related injury. In most cases, the employee may be eligible for workers’ compensation in addition to the sick time taken.

Workers’ compensation is no doubt, a highly beneficial program for employees who are hurt or taken ill while on the job. The benefits are paid to genuine claimants based on the medical evidence available to establish the injury or illness. Workers’ compensation attorneys working for employers and insurers ensure that the claim is valid by extracting relevant medical proof with the support of medical review services. It is important for employers to understand that workers’ compensation insurance can protect them from litigation if a worker is injured or becomes ill while on the job. If a major claim arises and the employer lacks funds to pay it, workers’ compensation insurance provides the required protection for the business.

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