Understanding Workers’ Compensation Eligibility and Requirements

Workers compensation is meant to swiftly avail financial and medical attention to employees with job-related illnesses or injuries while ensuring employer and employee don’t have to go through costly legal battles.

What’s Workers’ Compensation Insurance?

You’re legally obligated to provide a safe workplace for your workers as an employer. However, accidents can happen even with the best safety measures in place, and that’s where workers comp comes into play. Workers comp insurance has two functions. Firstly, it covers injured workers’ medical care as well as part of their income while they are unable to work. Secondly, it protects employers from being sued by workers who’ve been injured at work.

Workers get benefits regardless of who is at fault for the accident. In case a worker is killed due to workplace injuries, workers comp covers their death benefits. While the concept is simple, each state has its own workers’ comp eligibility and requirements.

The Injured Worker Should Be Classified as an Employee

In general, it’s only your employees who can file workers’ compensation insurance claims against your business. But, the definition of an employee varies by state. Individuals who are considered independent contractors in one state may be considered employees in another state. Moreover, there are many legal gray areas regarding workers’ compensation requirements. For instance, if an employee working for a subcontractor is injured at work, who is responsible for the workers’ comp benefits? Is it the owner of the project, the general contractor, or the sub? To avoid workers comp-related conflicts, you should ensure all your contracts clearly outline your responsibilities regarding workers’ compensation.

Covered employees can work part-time or full-time. If an individual is expected to work in a given location for certain hours for your business, they are likely regarded as an employee even if they are not eligible for other benefits. In contrast, contractors usually set their working hours and are not necessarily required to work in an employer-designated workplace setting. In most states, contractors include all kinds of freelancers and workers who choose their working hours, like Uber drivers and certain agricultural workers.

Employer Must Be Insured

Generally, all businesses that have workers are required to carry workers comp insurance. Businesses pay insurance premiums to private insurance companies or state-run workers’ compensation funds that manage the benefits. Each state has an agency that oversees workers’ compensation. Once an employee has signed off on the offered benefits or compensation, they lose their right to sue their employer for work-related injuries.

Injury Must Be Work-Related

Workers’ compensation insurance only covers work-related illnesses and injuries. Workplace accidents that aren’t due to an employee’s misconduct are covered. Workers comp insurance also covers repetitive-motion injuries which result from cumulative effects or certain jobs like typing on keyboards or lifting heavy objects while stocking shelves. Workers comp also covers illnesses resulting from working conditions. For instance, exposure to asbestos at work can cause a worker to develop mesothelioma.

Meet Reporting Deadlines

Each state has set a time frame within which employees should report and file workers’ comp claims. The time requirements vary by state as well as the kind of work-related injury or illness involved. One of the deadlines relates to when an employee should inform their employer about their condition. The second deadline relates to when the employee must file their workers’ comp claim.

Attend All the Necessary Medical Appointments, Treatments, and Examinations

Some workers may attempt to obtain workers comp benefits fraudulently. Some of the red flags include rescheduling medical appointments, like doctor visits or diagnostic procedures like MRI and X-rays. If an employee skips a doctor’s appointment while still getting lost wages benefits, the insurance carrier and/or the employer can assert the employee is being medically non-compliant—medical non-compliance grounds for withholding wage benefits.

How to Get the Right Workers’ Comp Plan?

For a workers’ compensation insurance policy that will adequately protect your business as well as your employees, contact us at Pittman Insurance Group, LLC.

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