A Comprehensive Guide to Worker’s Compensation Insurance Coverage

Business owners purchase worker’s compensation insurance to protect their workers. The policies are mandatory for companies with over one employee. Unless the other worker is the business partner, they require the coverage. Under worker’s compensation laws, the employer must complete a claim according to federal and state guidelines. Reviewing a comprehensive guide to these laws and insurance policies helps employers avoid compliance violations.

Purchasing and Maintaining Coverage

Federal laws require all employers to maintain worker’s compensation insurance policies if they hire over one worker for their business. The insurance provides fast medical payments for the injured worker, and it offers replacement wages for the workers if their recovery prevents an immediate return to work. The replacement wages won’t exceed 90% of the worker’s normal wages, and the insurer needs an income statement from the employer that shows the worker’s exact wages. The insurer requires the employer to follow the exact guidelines for processing a claim to avoid denials because of claim’s issues. Company owners can learn more about worker’s compensation insurance by contacting Paige & Campbell for extended details.

Starting a Claim for an Injured Worker

Human resources managers must start by sending the injured worker to get medical assistance, and they must send a claim’s form with the worker. The doctor treating the injured worker must complete a medical report within ten days of treatment, and they must send a medical report to the insurer and the employer. The policy pays for the initial assessment because the worker was injured on the job. The HR manager must complete all forms according to federal laws and the terms of the insurance policy. The human resources manager and the employer do not decide if the worker qualifies for the worker’s compensation benefits, but they must submit the claim for processing.

Necessary Guidelines for Qualifying

To qualify for any worker’s compensation benefits beyond the first treatment, the worker must have a condition that was caused while performing their job duties or hazards in the workplace. The worker cannot play a role in causing their injuries and still receive benefits. The business type defines what hazards are possible in the workplace. For example, if the company manufacturers products with chemicals, the workers are at risk of sustaining chemical burns if they do not have personal protection equipment provided by their employer.

Business owners must understand that (1) they are responsible for filing the worker’s compensation claim, (2) they cannot deny worker’s compensation for an injured worker, and (3) they must have company policies related to conditions that could cause a worker-related injury. The terms of the policy define all qualifications and conditions that could disqualify for the worker for coverage. The employer must add these conditions to their company safety policy and enforce it to protect their workers.

Defining the Workplace

The workplace begins with the business location, and all areas connected to the commercial building. This includes the primary workspace, the parking lot, locker rooms, bathrooms, and any area accessible to workers. Businesses that send workers to an on-site workplace must cover the workers within these spaces, too. If they perform services for clients at the client’s home, the location becomes the workplace until the worker completes these services. For example, a construction company provides worker’s compensation coverage for workers at construction sites. The locations aren’t the primary workplace, but the workers complete the company’s services in the locations.

Companies that delivery products via commercial vehicles must cover their workers when the workers are driving to and from the client’s location. If the worker is injured while driving, load, or unloading the products, these injuries are covered under worker’s compensation coverage.

The Claim’s Adjuster’s Role

A claim’s adjuster must evaluate the entire worker’s compensation claim and ensure the company followed all guidelines when completing the claim. The claim could be disqualified for missing deadlines or for a lack of information. The claim’s adjuster will ask the employer for any additional documentation that wasn’t included in the original claim. They review the terms of the individual policy and ensure that the accident qualifies for coverage.

Next, the adjuster reports their findings to the employer and the insurer. If the worker is denied coverage, the worker receives a letter explaining why they didn’t qualify. If the worker qualifies, the adjuster sends information to the worker such as the amount of replacement wages and when these benefits start. The date for the last payment appears in the correspondence, too.

What Happens If a Worker is Denied?

When a worker is denied worker’s compensation, the worker has the option to file a legal claim against the insurer and the employer. However, they must have medical documentation showing that they qualified for benefits and were turned down. The worker cannot file a legal claim simply because they didn’t like the outcome. They must also prove that they played no part in causing their injuries. Comparative fault rulings could disqualify the worker because of their role in the accident.

What Disqualifies a Worker for Coverage?

Terms of the policy require the emergency room or urgent care doctor to conduct a drug and alcohol screening for all injured workers. If they fail the screening, the worker is disqualified for benefits. If the worker sustained injuries because they didn’t wear PPE, the worker is at fault. However, if the employer didn’t provide PPE for the worker, the employer is at fault. Company safety policies must identify proper work attire for specific job roles pertaining to safety. If a work failed to wear slip-resistant shoes and fell, they played a role in causing their accident.

Business owners must purchase worker’s compensation insurance according to federal employment laws. The laws apply if the employer hires more than one worker, and it doesn’t matter if the workers are related to the owner. Worker’s compensation covers worker-related injuries, and the workplace must be well-defined to the workers. The employer must file a claim for all worker-related accidents, and a claim’s adjuster decides if the worker qualifies. Reviewing worker’s compensation policies and laws ensure that the employer is compliant.

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