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Home Money A Brief Review of Worker's Compensation Insurance Coverage

A Brief Review of Worker’s Compensation Insurance Coverage

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Business owners must follow all federal laws when it comes to their employers. OSHA has regulations for maintaining a safe work environment, and employers must comply with these regulations to prevent worker accidents and injuries. In addition to providing a safe workplace, employers must purchase insurance policies that provide protection for their workers. Worker’s compensation insurance coverage is a necessary part of managing accidents in the workplace, and the policies help the company protect itself against serious financial losses. The insurance provides coverage for a variety of accidents and injuries that could occur in any workplace.

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When Does the Employer Need Worker’s Compensation Coverage?

Employers are required by law to purchase and maintain worker’s compensation insurance coverage for their workers. The insurance coverage provides assistance for the workers when they are injured on the job. It provides payments for all the worker’s medical expenses if they are eligible for benefits. Business owners can find out more about worker’s compensation insurance by contacting Paige & Campbell Insurance now.

Does the Employer Need to Expand Their Coverage?

Workers Compensation Claim

Expanding existing coverage is necessary when the company grows and adds more workers. The business owner will need to assess the maximum coverage limits and add more workers to their policy. It is necessary for the company to increase its coverage to include all workers and ensure they have enough coverage for a larger collection of workers. More workers equate to more liabilities, and the business must ensure they have a greater coverage limit to provide adequate benefits for workers. With the emergence of the recent pandemic, employers have seen far more liabilities that have placed their workers at risk. Their worker’s compensation coverage must provide benefits for all workers that sustained an injury in the workplace, including exposure to COVID-19.

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How to Start a Worker’s Compensation Claim

The human resources managers must start the worker’s compensation claims, and they will complete the documentation for the worker before sending the worker to an urgent care facility or an ER. The documents include a medical report for the doctor to complete after examining and treating the injured worker. The medical report must be submitted within ten days of treatment and diagnosis. All documents for the claim are sent to the insurer who then assigns an insurance adjuster to the case.

The insurance adjuster reviews all angles of the accident and determines if the worker and their injuries are eligible under worker’s compensation guidelines. If possible, the adjuster reviews the footage of the accident and assesses what happened. If the worker is approved for worker’s compensation, the claims adjuster sends a letter to the worker notifying them of their approval. If they are denied, the claims adjuster sends a letter explaining why they were denied.

Drug and Alcohol Screenings For Injured Workers

Drug and alcohol screenings are necessary for all injured workers, according to worker’s compensation guidelines. If the injured worker fails the screening, they are disqualified from receiving benefits immediately, and the insurer will not provide any benefits beyond the payment for the initial medical assessment. All employers have company policies that require workers to refrain from using drugs or alcohol on the job, as the substances increase the potential for an accident. If the worker was under the influence, they will not receive any benefits through worker’s compensation, and the worker is held accountable for their own injuries.

The Role of the Claims Adjuster

The claims adjuster is assigned to the worker’s compensation claim to find any loopholes that disqualify the worker’s claim. They conduct a thorough investigation of the event that caused the individual’s injuries. They determine if the worker was in the workplace when the accident happened and if there are any conditions that could disqualify the worker based on their actions or failures to comply with the company’s policies. All it takes with worker’s compensation claims is one violation of company policies and the worker will not receive benefits.

What Benefits Do Workers Receive?

Worker’s compensation benefits include full medical payment for the injured worker. This includes testing, medication, surgery, and procedures required to treat the injury. Medical equipment that is prescribed for the injured worker is covered through the insurance policy. The worker will not have to pay for any of their medical requirements related to their work-related accident. The worker can send all the invoices to their human resources manager to manage the payment for these expenses.

If the worker is not able to return to work immediately, they can receive wage replacement benefits. The benefits range up to 90% of the worker’s wages. The claims adjuster explains when the worker will receive these payments and how much they will receive.

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What Can Disqualify the Workers?

Injured workers can be disqualified for worker’s compensation according to worker’s compensation guidelines and company policies. For example, company policies define proper work attire and personal protective equipment the worker must wear when working. If the worker was injured and wasn’t wearing their PPE, the claim is denied. If the injury happened after business hours, the worker would need to prove why they were in the workplace and how they sustained a work-related injury. If the worker is an independent contractor, the coverage is available only if the employer sends the contractor to a worksite or if the contractor must visit the workplace to complete their job duties.

Business owners must purchase worker’s compensation insurance policies for providing coverage for workers who sustain injuries in the workplace. The insurance policies provide payments for the worker’s medical expenses and will provide wage replacement if the worker is unable to go back to work immediately.

The claims start with a complete medical assessment of the worker’s injuries, and a doctor must complete a medical report for the insurer. The insurance company provides a claims adjuster who investigates the accident that caused the worker’s injuries. The claims adjuster determines if the worker complied with all company policies. Reviewing all requirements for worker’s compensation insurance coverage helps the employer get adequate coverage for their workers and reduces liabilities that could prove costly for the business.

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