Workers Compensation - Healthcare

Workers Compensation

What is Workers Compensation?

Workers compensation is also called as Workers Comp or Workman’s comp. It’s a type of insurance, which is purchased by an employer in order to cover medical care benefits of their employees who are injured on job or illness caused from their work.

By this we can clearly say that workers compensation protects the employees by covering the diseases, infection and injuries which is occurred during work related, and also it covers portion of employee wages.

What is the purpose of buying Workers Compensation?

The two main purpose of workers compensation is:

  1. Workers comp assures the employee to get medical care, wages, professional rehabilitation if needed, compensation when employee lose wages while they are unable to return to work and death compensation to their dependent if its work related.
  2. Workers Comp protects the business of the employer from lawsuits by employees due to work place exposures.
What does workers compensation cover?

Workers compensation covers the costs related to work place injuries for employees and this coverage depends and it includes ambulance, medical expenses, medication, physical rehabilitation, missed wages, disability compensation, death compensation to dependents and funeral expenses. It also protects the employer’s risks from being sued by employee for negligence or threat of lawsuits by covering legal defense costs.


What are not covered by workers compensation?

Employees not covered by workers compensation may vary state by state in United States of America. Workers compensation does not cover if an employee found injured when:

  • Negligent (Not followed the company policies and safety rules).
  • Found it’s done intentionally.
  • Intoxicated or influenced of drugs.
  • Found stress related or mental Health conditions which are not from your job.
  • Horseplay or fighting.
How much is workers compensation Insurance cost?

Workers compensation insurances varies state by state and depend on number of different factors to come up with your premium costs such as:

  • Payroll
  • Types of job workers do (Classification codes)
  • Number of Employees
  • History of claims
  • Industry and etc.,

Workers Compensation premium cost = Workers classification code rates X (Payroll/$100) X Claims experience modifier


How and where do I get Workers Compensation insurance?

You must be an employee/worker to get workers compensation insurance and your employers should pay the premium and get these workers compensation insurance. An employer with a certain amount of employees and certain type of businesses must get workers compensation insurance as per the most of states law. But this amount of employees and policy requirement for its businesses varies state by state, as each state has its own workers compensation laws and regulation in United States of America.

Employers will get workers compensation insurance from either through State fund or with a licensed insurance company/Broker.


What should employee do if injured on the Job?
  • First obtain medical attention – first aid or necessary medical treatment with authorized providers except in an emergency. In an emergency case you can visit nearby providers and get treated.
  • Second step, employee should report the injury immediately to their employer or supervisor regarding the detail of the Incident. (For example: How injury occurred? What type of injury? When (Date and time) this injury occurred? What is the cause of the incident? Body part injured, and so on).
How to file a workers compensation Claim?

Each state has own deadline to file a workers compensation claim, hence employee/employers should file the claim within the time frame stated in order to get reimbursed.

As soon as an employee gets injured and reports the incident to the employer. An employer should provide the necessary claim forms to be filled by an employee in order to submit those claim to the workers compensation insurance.

Employers then will file the claim form to the workers compensation insurance for processing and employee’s doctors submit the necessary medical reports.


Who chooses treating physician in workers compensation injuries?

 If its work related injury and found it’s an emergency care required, then go to the nearest emergency room and get treated. Suppose if in case it’s non-emergency, then employer or workers compensation insurance directs the employee to see certain hospital or doctor in order to cover that claims from workers compensation insurance.

Note: In some states employee has right to choose the own treating physician from the list of physicians that the state has approved for treating workers compensation injuries as long as employer offers only group health coverage and doesn’t have managed care arrangements.


What reports to be submitted while submitting Workers compensation claim?

These are some of the important reports to be submitted when workers compensation insurance required based on the incident:

  • First Investigation Report
  • Accident Report
  • Medical Records
  • Witness Reports
  • Employers Reports
  • Ombudsman’s Reports
What are the main reasons of denying Workers Compensation Claims?

There are several reasons for denying the workers compensation claims, but the main reasons are as follows:

  • Non Compensable Injury – The injuries which are not compensable under the law.
  • Pre-Existing Conditions.
  • No supporting medical documentation.
  • Failure to report the work related injury on time.
  • Not a work related injury/illness.