Without the proper tools or education administering a workers’ compensation claim may be a headache for some organizations. Managers and employees alike should be trained on when, where, and how to report a work-related injury or illness.
The first step to successfully administering a workers’ compensation claim is for organizations to have a well written policy on what to do when a worker’s compensation situation occurs. Managers and employees alike must have access to this policy at all times. Thus, it is always a good idea to include a workers’ compensation insurance policy in an organizations employee handbook. Timing is a key factor in reporting a work-related injury or illness, therefore a lack of knowledge on how to report such injury or illness may result in an employee being denied workers’ compensation benefits.
The next step to successfully administering a workers’ compensation claim is the reporting of such work-related injury or illness. Employees who experience a workplace injury or illness should immediately notify their Manager, or whoever the organization has designated in their policy as the designated contact person. The Manager, or designated contact person will determine at the time of the injury or illness, any type of first-aid that may be required on the scene, or if further emergency care is warranted. Depending on the significance of the injury or illness, the employee’s emergency contact may need to be communicated with by the Manager, or the organization’s designated contact person. For this reason, it is extremely important to always have available up-to-date emergency contact information on every employee in the organization. While attending to the employee with the injury or illness, the organization should also ensure that the scene of the incident is secure, in order to prevent any additional incidents from occurring.
The next step to successfully administering a workers’ compensation claim is to make sure that after the report of a work-related injury or illness has been made that the Manager, or the designated contact person meet with the employee to complete the “First Report of Injury” form. This form may be provided by the organization’s workers’ compensation insurance carrier, or by the specific state’s workers’ compensation agency. It is recommended that the employee assist the Manager, or the designated contact person with the completion of the form. This ensures that the form is thoroughly filled out and all of the details have been covered. The report generally requires the following information: date of the injury or illness, the place where it occurred, a description of the injury or illness, the date the employer became aware of the injury or illness, the date that the employee received the form, the date the employee returned the form to the employer, and any other required information related to the injury or illness.
The organization’s next step requires evaluating whether the employee needs to be seen by a physician and who will pay for those services. Some states have specific laws regarding physician selection. In many states, an employer may initially select the specific physician who the employee with a work-related injury and illness must see. For example, Indiana is an employer choice state, so employers in Indiana may select the physician that an injured or ill employee sees. It is recommended that a list of physicians that have contracted with the employer be supplied to the employee at the time of the incident. Medical expenses are another important topic to cover with the employee. After all, someone is going to have to “foot the bill” for the employee’s medical expenses, and that usually ends up being a combination of the workers’ compensation insurance carrier and the employer. To ensure that the medical bills are sent to the appropriate place for payment, the employer should send the “First Report of Injury” form to their workers’ compensation insurance carrier when they send the employee to see a physician. In addition, the employer should supply the physician’s office with the workers’ compensation insurance carrier’s information. Also, travel to and from treatment may be reimbursable through the workers’ compensation plan, or in accordance with the specific state’s workers’ compensation laws. It is important to note that the employee may be required to submit to a drug and alcohol test per either the workers’ compensation insurance carrier’s policy or the company’s drug and alcohol post-accident policy. Workers’ compensation insurance coverage for the employee is typically contingent upon the successful completion of a drug and alcohol test. In some cases, a positive drug and alcohol test result may nullify the employee’s workers’ compensation claim which will void their wage replacement and medical payment coverage.
The next step to properly administering a workers’ compensation claim is to determine how the employee will be compensated for their time away from work. A designated contact person from the organization will need to discuss how wage replacement benefits work with the employee. Depending on the state wage replacement benefits vary. The employee may be entitled to 66 and two-thirds percent of wages up to 100 percent of the states average weekly wage after a specified waiting period. The designated contact person from the organization may also want to inform the employee of the use of paid leave benefits such as sick leave, vacation, or any other paid time off benefits that are able to be utilized during waiting periods and periods of wage replacement in order to make the employee whole from a wage perspective. Again, just like wage replacement benefits, the use of paid leave benefits while receiving workers’ compensation benefits vary by state law. Also, important to note, if the employee is eligible for the Family and Medical Leave Act (FMLA), the employer must provide the employee with the required notices as workers’ compensation and the FMLA run concurrently.
As stated above, it is always a good idea to send the “First Report of Injury” form to the workers’ compensation insurance carrier at the same time or near the same time that the employer is sending the employee to see a physician. Depending upon the workers’ compensation insurance carrier, submission methods may vary as some carriers prefer electronic submission where some require the use of a telephone system. Also, per specific state laws, organizations may be required to send the report directly to the state’s workers’ compensation agency. Regardless of how the organization is required to report the work-related injury or illness, the organization must always stay in contact with the workers’ compensation insurance carrier. Consistent contact with the workers’ compensation insurance carrier will ensure that the employee receives the benefits that they are entitled to receive. There also may be important medical documentation that the organization may need to send to the workers’ compensation insurance carrier that includes information such as: number of lost workdays, the employee’s return-to-work status and any salary continuation to determine wage replacement benefits.
Not only does the organization have to stay in touch with the workers’ compensation insurance carrier, but the organization must also stay in contact with the employee. The designated contact person from the organization should inform the employee that their claim has been submitted to the workers’ compensation insurance carrier as well as the timeframe in which they may expect to be contacted by the workers’ compensation insurance carrier. A consistent schedule should be established between the employee and the organization’s designated contact person for communication either by phone, text, or email. Consistent communication also lets the employee know that they are valued and that returning to work is important.
Perhaps the most important piece of administering a workers’ compensation claim is communicating with the employee on how the organization plans to return the employee to work. This process starts with establishing a timeline for the employee to return to work. The organization, in accordance with the Americans with Disabilities Act and its Amendments Act (ADAAA) may need to accommodate the employee’s physician-directed restrictions in order to successfully return he or she to work. Again, the organization will also need to consider if the workers’ compensation leave will run concurrently not only with the Family and Medical Leave Act (FMLA), but also with the Americans with Disabilities Act and its Amendments Act (ADAAA), and state specific leave policies or a company-provided leave of absence policy. When creating a workers’ compensation insurance policy for the organization’s employee handbook, including how workers’ compensation leave interacts with the FMLA, ADAAA, etc. is crucial.
After communicating with the employee and the workers’ compensation insurance carrier about returning the employee to work, the single most important part of this process is returning the employee to work. Just because the employee has returned to work does not mean that they are “fit” for full duty. The employee may have physician-directed restrictions to include limited lifting of heavy objects, limited standing for prolonged periods of time, etc. Some organizations have “light duty” work for an employee that corresponds with their physician-directed restrictions. If the organization does not have “light duty” and the employee is eligible for the FMLA then the employee staying on FMLA is definitely an option. The benefit of “light duty” is that it may not count towards an employee’s FMLA leave because the employee has returned to work. It is important to note that the organization may not discipline or retaliate against an employee who is on a workers’ compensation leave or on FMLA. However, the employer is allowed to restrict the employee from receiving wage replacement benefits through workers’ compensation, or short-term disability if available, when they have returned to work based on the physician-directed restrictions.
In some situations, the physician seeing the employee who has a work-related injury or illness may not believe that the employee is ready to return to work even with restrictions. This period of time may be a few months and or may even be indefinite. The organization will have to revisit the FMLA, ADAAA, and other appropriate leave options under their current policies and practices to see if the employee is eligible for additional paid or unpaid leave. Certain states have anti-retaliation provisions within their workers’ compensation laws that state that organizations may not terminate an employee while they are receiving workers’ compensation benefits. Aside from those state-specific laws, the organization may not be obligated to continue to employ the individual. However, in these situations organizations are strongly encouraged to seek legal advice before officially terminating an employee.
For more information about the administration of workers’ compensation claims, please contact us at www.NewFocusHR.com.
Written by: Patrick McKenna, SHRM-CP