Workers’ compensation claims ensure workers receive necessary benefits after workplace injuries and illnesses. Workers’ compensation aims to provide income replacement and foster a safer, more transparent work environment. Working with experienced benefits specialists such as Ethos Benefits can help both employers and employees navigate the complexities of workers’ compensation, ensuring claims are handled efficiently and in compliance with all requirements.
Here are 7 compelling reasons why employees and employers should be well-informed about the nuances of workers’ compensation claims.
Deadlines
Employees, employers, and insurers have specific deadlines they must meet. There are time limits associated with notifying various parties of an injury or illness and filing necessary documentation. Workers’ compensation claims need to follow a specified timeline to have the potential to be accepted.
When an injury or illness occurs, the afflicted employee must immediately report the incident to their employer, usually within 10 days. In other cases, they may extend to 30 days. Either way, a timely report prevents the loss of an employer’s rights to workers’ compensation benefits.
The employer then has the responsibility of reporting the claim to an insurer. They must report a fatality within 8 hours, amputations, the loss of an eye, and inpatient hospitalizations within 24 hours.
Legal Obligations
Employees and employers need to understand the steps involved in workers’ compensation claims.
An employee, or a relative of the injured employee, needs to retain records of the medical treatment that was received. This proof of treatment will help increase one’s chances of their claim being accepted.
Furthermore, the injured or ill party must retain any receipts for mileage, public transportation, and other necessary expenses involved in the medical treatment. An employee’s aim here is to claim these expenses back from their employer.
Once all necessary steps have been taken by the employee and employer, the injured party will receive notice from the insurer covering their case. Review these documents – your case, your rights, and your responsibilities – very carefully.
Scenarios Covered
You can claim for any injury or illness that occurred at your workplace that prevents you from working at your normal capacity. However, there are intricacies to this rule – some circumstances may not result in the offer of financial recovery.
An employee can claim back for work-related injuries, work-related illness, and repetitive stress injuries. These include, but are not limited to, traumatic brain injuries, spinal cord trauma, internal bleeding, loss of a limb, loss of a sensory organ, and 3rd- and 4th-degree burns. Another party’s negligence leading to your accident would also be covered (e.g., another individual’s failure to adequately install scaffolding).
Costs Involved
Everyone should be aware of the multitude of costs of workers’ compensation coverage. Insurance varies depending on myriad factors, such as an employee’s payroll, industry, claims history, and type of work.
Hire a worker’s compensation attorney to increase the likelihood of your claim being accepted. However, be aware of the costs involved in hiring an injury lawyer.
Some attorney’s and lawyers’ fees are contingent on the outcome of your case. Ensure you know from the get-go how their fees are set. In certain cases, you may pay nothing if your case doesn’t yield any benefits or damages.
Financial and Familial Problems
Uncovered work-related injuries and illnesses can lead to detrimental financial and familial problems. Therefore, knowing if you, as an employee, should, for example, get critical illness insurance, is crucial.
The potential financial implications of someone falling ill or attaining an injury are vast. Ensure you know what should be covered by your employer and insurer:
- Short-term medical treatment (ER visits, surgeries, prescriptions).
- Long-term medical treatment and ongoing care (disability benefits, physical therapy).
- Lost or missed wages (during your recovery period and if you can’t ever return to the same job).
- Death benefits (funeral costs and benefits for the employee’s beneficiaries).
Potential for Denial
There is always the potential for the denial of a worker’s compensation claim. Know what could go wrong to make sure it doesn’t.
These are some of the reasons your claim could be denied:
- The injury occurred outside of work (it must have occurred within the course and scope of your employment).
- Being under the influence of a substance when the injury occurred.
- The failure to be treated by a qualified medical practitioner.
- The injury was a result of horseplay/roughhousing/practical jokes.
- The injury was directly caused by a pre-existing, known condition.
- Failure to hire an experienced workers’ compensation attorney.
- Potential fraudulence.
Selecting The Right Coverage
Employers should be mindful of having the details of workers’ compensation claims available for employees to access upfront. Employees should ask about these details before any injury or illness can occur.
Employers should have an approved list of licensed medical practitioners who the Worker’s Compensation Board authorizes, have someone onboard the team who handles these claims, as well as attorneys and other professionals available for employees.
These workers’ compensation provisions reduce employers’ and business owners’ liability for work-related injuries and illnesses. It’s easy for employees to sue if an employer lacks this coverage.
