How Does Workers’ Compensation Work?

Injured workers may be eligible to file workers' compensation claims.

Having an employee suffer an injury on the job can be a scary idea. You worry about their recovery and the impact the injury could have on your operations. How does workers’ compensation work when an accident happens? It takes time, but it offers you significant protection.

The Lake Region Insurance Agency team has a wealth of expertise in all insurance types, including workers’ compensation insurance. Our experienced agents have the tools to help you make an informed, educated choice to obtain the protection you need.

Keep your business secure by protecting your operations in the event of an employee injury. Give us a call or stop by one of our Greater Minnesota offices to understand all of your options.

How Does Workers’ Compensation Insurance Work?

As the name suggests, workers’ compensation is a specific type of insurance policy explicitly designed to support workers. Employees who experience a work-related injury or develop an illness due to their work have protection under this sort of plan.

Workers’ compensation insurance can cover the costs of medical care needed due to injury or illness. These bills can be very high and may prohibit the injured employee from accessing the right treatment for their condition on their own. But workers’ comp gives them the coverage to seek medical care.

How does workers' compensation work if your employee gets hurt?

In addition, worker’s compensation insurance can help cover the loss of earnings. The injured worker may be eligible to receive a portion of their wages for the period they are off work. The amount will vary depending on the individual state’s law.

Policies also may offer permanent disability coverage and death benefits. Although no one wants to consider these possibilities, it’s crucial that you have a policy in place that provides the right protection.

In addition to it being a smart business practice, carrying workers’ compensation insurance is a legal requirement in most states. And the states typically set the guidelines for what your policy must cover.

What Happens If There Is a Claim?

Worker’s compensation claims generally have very specific steps and protocols for the employer and employee to follow. Your insurance agent will be able to walk you through the process for your state. 

Filing a claim requires a lot of reports.

Typically, the following things must happen:

  1. Employee Report – Any employee who suffers an on-the-job injury or develops an occupational illness must report the situation to their employer as quickly as possible. Most states have a strict timeline for this step to validate a claim. The report needs to include the time and date of the incident and the names of any witnesses.
  2. File the Claim – Most likely, both you and the employee will have forms to file to initiate the claim with your insurer. The worker will need to submit medical records to substantiate their claim.
  3. Medical Care – The injured worker must seek medical assistance right away. Not only could a delay be detrimental to their health, but it could render the claim invalid. The medical professional will need to provide a report to go with the claim.
  4. Follow All Instructions – Stay on top of any forms or information you need to provide to the insurer while the claim is open. Delays or omissions can cause significant problems for you and the employee. 
  5. Follow Medical Recommendations – The employee’s return to work must be under medical approval. Do not pressure your employee to come back against medical advice. And be realistic about what a return to work will look like for your employee. They may not have medical clearance to return to full-time duties. You may need to offer a reduced schedule or responsibilities. No matter what, only allow your worker to be back on the job when their doctor approves it in writing.

How Many Accommodations Do I Have to Make?

The Americans with Disabilities Act (ADA) requires businesses to make reasonable accommodations for workers who experience disabilities, whether they are job-related or not. Unless you can prove an unreasonable hardship to your company, you will need to comply with the requested accommodations.

Injured workers may need accommodations.

Some of the most common changes you may need to consider include:

  • Shifting the employee’s job requirements – For example, if a person has a back injury from working in the warehouse, they may need to switch to a desk job.
  • Reducing the employee’s work hours
  • Providing more frequent workday breaks
  • Adding a ramp to enter the building
  • Allowing for remote work

Can My Employee Sue Me Because of a Workers’ Comp Claim?

In most instances, workers’ compensation offers you protection against a lawsuit from the injured employee. Unless you were grossly negligent or intentionally caused the injury, you probably are safe from legal action. Just be sure you follow all the necessary steps in the claims process.

Non-Eligible Injuries

There are situations when an injured or sick employee cannot file a workers’ compensation claim. These instances include:

  • Intentional, self-inflicted injuries
  • Injuries resulting from a fight the employee started
  • Injuries resulting from the employee’s use of drugs or alcohol
  • Injuries resulting from the employee’s commission of a crime

How Worried Should I Be About Fake Claims?

Insurance fraud is a significant concern, and workers’ compensation fraud occurs in about 1-2% of cases. The good news is that most insurers are quite thorough when investigating a claim. After all, they are the ones paying for the medical care and other covered expenses.

Fraudulent claims require investigation.

Investigators are careful to watch for signs of false claims, such as:

  • Late Reports – Employees who file a report about an injury that happened a week or more before are more likely to be lying than those who report promptly.
  • Monday Mornings – Insurance companies are quick to investigate Monday morning reports because there is a chance the injury occurred off the job during the weekend.
  • No Witnesses – The lack of anyone to corroborate an employee’s claim can raise a red flag to insurers.
  • Vague and Unclear Details – If the explanation of what happened doesn’t fit the normal circumstances or job duties, investigators may do more digging.

If you have any concerns about a claim’s validity, talk with your insurer. Let their personnel do the investigation. On your end, be sure to keep clear and detailed notes about what you see and hear from the injured employee and other workers.

Let’s Find You the Right Coverage

The independent agents at Lake Region Insurance Agency can help you find the right workers’ compensation policy. Protect you, your employees, and your business with this critical insurance plan. 

We are available to serve you from our offices in New London, Willmar, and Cokato, MN. We look forward to hearing from you today.

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