Workers Comp & Risk Management

A workers compensation claim may be filed through a person's employer, if an accident or injury happens in the workplace resulting in loss of work and wages. There are many steps to filing successful workers comp claims, as well as risk management that should be followed to prevent accidents and injuries in the workplace.


1. Workers Comp Claims

Knowing who can file a workers compensation insurance claim is important for those trying to get benefits. Typically, only employees can file for workers comp, as long as the injury results from an incident or accident that happened at work. A spouse or a dependant is not permitted to file any type of claim through workers comp, such as a loss of service. If the spouse dies because of a work-related accident, spouses or dependants can than seek both death benefits and help with expenses related to the funeral under workers compensation insurance. Death benefits will typically include the cost to bury the spouse, even if they also had a life insurance policy.

Claim procedures may differ for each state. However, most businesses require their employees to tell them of their injuries within a set number of days after it has happened. One exception to this rule is generally if an employee has been deemed mentally incompetent because of his or her injuries. They may then be excused from these requirements. Sometimes, the employee must let the state industrial commission aware of the problem too. Once filed, an employee can usually receive medical expenses and lost wages paid.

When an employer has been made aware of an employee's injury, they should then notify their workers compensation insurance. From there, the proper steps will be taken to file a workers compensation claim.

2. Tips On receiving Workers Compensation

Getting workers comp may be difficult. Getting through the maze of paperwork can be even harder. Following the tips provided here can help your claim be resolved as quickly as possible.

Getting your own copy of your workers comp claim is important. This lets you know that your employer has actually filed it, and you will know what is on it. The possibility may then arise of the workers compensation insurance company denying your benefits. If this happens, make sure to file an application as quickly as possible for a hearing with your state workers' comp board. Make sure you read and understand your claim as well as you can, and make copies of anything that may be important. Make sure you have enough copies of all your important medical records, at least two copies of everything. Also, make sure that all your information is correct, and that you have had all the important medical exams and information gathered for your case. Everything should be clearly documented. The medical reports must include how you got hurt at your place of employment and be detailed about the incident, as well as the steps you are taking to recovery.

3. Injuries Covered By Workers Compensation

There are four types of injuries that workers comp usually covers. The first is called traumatic physical injuries, and it is the biggest compensation claim that is made by workers. Repeated trauma is the next most common claim reported towards a workers compensation claim. A repeated trauma is an injury that occurs gradually, such as tearing of the muscles or ligaments from a certain activity at work. These may be harder to claim, as many employers will argue that they were done outside the workplace. If the injury can be proved that it happened from a repetitive motion at work, the worker may have a winnable case.

Mental injuries are the third type of injury that may make a person eligible for workers compensation insurance. A mental injury can result from a physical injury, such as depression from not being able to work, or large amounts of stress in the workplace. In extreme cases, a significant event can cause a person to receive workers comp benefits, if they witnessed a tragic event at work, such as a death or horrific accident. Occupational disease is the fourth and final injury related to workers comp insurance. An example of this is if a large number of employees developed the same type of disease or infection from working at the same place of employment.

4. Workers Compensation Fraud

There are problems in the system of workers comp because of fraud. Losses happen when fraudulent claims on insurance are made, which also result in the holding up of legitimate claims. Many people and organizations can get caught up in fraudulent claims, such as attorneys, employers, health care providers, and the insurance companies themselves. When a claim is inflated or misrepresented, it may be classified as a fraudulent claim. A workers comp claim may be fraudulent, so employers must pay attention to make sure that all claims are legitimate. A workers compensation fraud occurs when an employee claims an injury at work when it did not happen at the workplace.

While there is no positive way to prevent workers compensation fraud, there are ways to watch out for it. One of these ways is to watch a disgruntled employee. A disgruntled employee may have motive to file a false claim if they were demoted or denied a promotion. New employees are statistically known for fabricating a workers claim, especially if other red flags have appeared. Another red flag for workers compensation fraud is if there were no witnesses to the alleged accident or injury at work, and if they happen on a Monday or a Friday.
Weeding out the fraudulent workers comp claims is best overall for the insurance companies and businesses. That way they are free to handle the real claims to get benefits to those who deserve them much quicker.

5. Possible Workers Comp Benefits

For those who have had legitimate injuries on the job, compensation benefits are entitled. State laws dictate the difference in benefits that an individual will receive. However, you can get a general idea of what you may be entitled to if you file a workers compensation insurance claim.

Those who file for workers comp may be eligible for temporary total disability, while they are unable to work and workers comp has yet to kick in. This is especially important when one cannot work because of their injuries, but are still waiting on their workers compensation claim to be approved. Workers comp may pay some or all your medical bills that resulted from your work injury. Those who qualify may also be entitled to permanent partial disability or total disability, if you cannot ever work again because of a work-related injury.

Those who file for workers comp may also be eligible for vocational rehabilitation training. This way, you may be able to work at a job that is better suited for you since your injury. If your injuries are permanent and cause restrictions that will never be fixed, your employer is usually responsible for offering you a job that can replace your old one. This job must be one that fits within the restrictions of what you are able to do now.

6. Workers Compensation Alternatives

One problem with filing a workers compensation insurance claim is that you may get into a financial bind while you are waiting for your workers comp claim to be approved. You may have to look into other alternatives, if you cannot work while waiting for benefits.

Social security disability benefits may be something the injured party can claim. To find out if you are eligible, you must contact your local social security office and go through a tough screening process. You may also contact your local unemployment office to see if you are eligible to claim unemployment benefits, while waiting for your workers compensation claim to come through. Your medical insurance should also cover many expenses of health care service.

It may be worth it to start looking into short and long term disability benefits, as well. You may be able to collect a percentage of benefits even after your workers comp has started. Another option to help pay bills may be to look into your credit card or mortgage insurance. Check into your accounts to see if you have something called tragedy insurance, which is an added protection that might cover a disability for a short period of time. You may be able to have your mortgage payments or credit card bill covered while you are having medical problems, which can really help in times of financial distress.

7. Occupational Safety And Health Act

The Occupational Safety and Health Act, better known as OSHA, requires that the workplace of every employer is free of recognized safety hazards that may cause injuries or death. This Act is an important part of risk management for both employers and employees, and should always be followed. This law states that all employees must be made aware if they are working with materials that may be hazardous. Special training may also be given to do a job safely.

OSHA laws can help keep employees safe. There are literally hundreds of regulations that an employer must follow under OSHA specifications. These include the proper storing and handling of hazardous material, equipment maintenance, fire protection, and first aid and medical treatment in areas where a small injury could occur. Risk management is the first step to keeping workers compensation insurance low.

8. Workers Compensation Medical Examination

Any claim made that is for workers comp can and will be examined by a doctor. The doctor who does the examination will, in turn, testify about any injuries for the insurance company. This doctor may not actually be treating you for your injuries, but is used to get information for the insurance company. It is very important to make sure this appointment goes well, so a legitimate claim is taken seriously.

There are ways to make a professional appearance to help your case along and to give you credibility. Make sure to keep your appointment. Understand that this appointment is only for the insurance company; therefore, try not to be on the defense through it. Be honest with your answers, and answer them to the best of your ability. Attempt to be as open and forthright as possible, and provide honest and straightforward answers. The results of your medical examination will go on to your insurance company, or your company's insurance company, so it is important that the answers are truthful and detailed.

While being examined, pay attention to details, such as the time the doctor spent with you. This is important because this doctor has to write out a detailed report of your injuries for your workers compensation claim. When your exam is over, you should quickly write up your own personal report of everything that happened and was said in the doctor's office.

9. Workers Compensation Terms

When a workers compensation claim is filed, there will be a lot of terms used that may become confusing. But it is important to understand them, so you can get the claim that you deserve.

AWW means average weekly rate. This refers to the average of 52 weeks before the day the injury or accident happened. TT is the acronym for temporary total disability. The number 15-8 is a part of the law that can give the carrier reimbursement from special funds. This will not change the amount of payment made to the worker, although it may make a difference to the settlement value at the end. CCP is short for carrier continues payments. An example of this would be "12/15/00 to date at $200, CCP at the same rate." The term HIA stands for held in abeyance, which simply means something that is set aside, or an issue that will be dealt with at a later time.

ANCR means accident, notice, and casual relationship. A worker that has been hurt must establish an ANCR to file a workers compensation claim. PPD is an important acronym meaning permanent partial disability, which is classified as a disability that has become permanent. Payments will continue in an SLU until an award is given, and then payments will stop. This brings us to an SLU - a scheduled loss of use. This means when a loss has occurred to a part of a body and can be scheduled, such as an amputation of a leg, or a 75% loss of vision to one eye.
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