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An Employer’s Guide to Handling Worker’s Compensation Claims
Here are the standard steps to for employers to use when administering a workers’ compensation claim. Employers should also review and comply with state laws, as state laws normally set the parameters for employer-required coverage, posting, reporting and determining what constitutes a workers’ compensation claim.
Step 1: Proper Training
Employers should train and educate employees on workers’ compensation coverage and related reporting requirements. Many employers create policies and procedures that are included in employee handbooks and procedure manuals.
Step 2: Report Incidents to Appropriate Parties
Per the employer’s established policies and procedures, employees should be trained to report the incident to the company’s designated person; usually a human resources representative. The representative should determine whether first aid is required and can be performed on the scene or if additional emergency care is required at a health care facility. Depending on the severity of the injury, the representative may need to notify the employee’s emergency contact of the incident. The employer should take immediate action to ensure that the worksite where the incident occurred is safe and secure to prevent additional incidents.
Step 3: Complete Injury/Illness Reports
If possible, the representative should meet with the employee to complete injury/illness reports. These forms are either created by the employer or some use forms provided by their worker’s compensation carrier. The report usually requires the following information: date of injury, 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. If the employee was given the report to complete, the representative should give the employee a deadline to complete it. If the employee needs to return the form via mail, the representative should direct him or her to mail it certified with a return receipt so there is a record of the date the employee returned it to the employer.
During the meeting, the representative should share with the employee the claims procedures, the benefits available to the employee and whom to contact for any concerns. Items frequently covered in this discussion include:
– Injury/illness report
– Physician selection
– Medical expenses
– Travel reimbursement
– Compensation benefits
– Family and Medical Leave (FMLA)
Step 4: File Injury/Illness Reports
Next the organization files the incident report with the company’s workers’ compensation carrier. Some employers may also be required by state law to submit the report to the state’s workers’ compensation agency.
Step 5: Stay in Contact with the Worker’s Compensation Carrier
Organizations must maintain contact with the workers’ compensation carrier on the employee’s claim. The employer may need to forward medical documentation to the workers’ compensation carrier. Moreover, the workers’ compensation carrier may have documents for the employer to complete. These documents may request information such as the number of lost workdays, the employee’s return-to-work status and any salary continuation to determine wage replacement benefits.
Step 6: Stay in Contact with the Employee
The representative next informs the employee that the claim has been submitted and when to expect contact from the workers’ compensation carrier regarding wage replacement and medical treatment. The representative should then establish a schedule of regular follow-up on the employee’s progress by telephone, mail or e-mail to let the employee know that his or her well-being and return to work are important to the organization.
Step 7: Establish a Timeline for Return to Work
Establishing a timeline for the employee’s return to work is imperative, as is making the determination about potential restrictions that may require accommodation and whether the employer will be able to accommodate the employee’s needs. An employer may also need to consider if workers’ compensation benefits will run concurrently with leave under the Family and Medical Leave Act (FMLA), the Americans with Disabilities Act (ADA), state leave laws or a company-provided leave of absence. The employer should have a policy in place that includes how leave interacts with workers’ compensation.
Step 8: Return the Employee to Work
Returning an employee back to work should be one of the main focuses for the employer, even if it is in a light duty capacity.
An employee’s return to work may have doctor-directed medical restrictions that may allow the employee to return on restricted or light duty, which is typically less physically and mentally demanding than the employee’s normal job.
Step 9: Continue Leave or Terminate When an Employee Is Unable to Return to Work
An employee’s doctor may provide a fitness-for-duty document that states that the employee is not ready to return to work and may not be able to return for some time or not at all. In this case, the employer will have to look at whether the employee is eligible for additional leave under the FMLA, the ADA, state leave or leave under the company’s policies and practices. Some state workers’ compensation laws have anti-retaliation provisions that may preclude an employer from terminating an employee for being absent due to a work-related injury; other states have legal precedent limiting an employer’s ability to terminate a worker receiving workers’ compensation benefits. Beyond these laws, there may be no obligation to continue to employ the individual; however, as with any termination, employers should seek legal guidance specific to their circumstances.