To protect employers as well as workers from potential financial risks caused by workplace injuries, almost all state in the US requires business enterprises’ with employees to get workers’ compensation insurance.
Michael Saltzstein is a visionary and specialist in the domain of strategic planning, financial structures, global risks, multi-line claims, and worker’s compensation. According to him, worker’s compensation insurance is a no-fault coverage that is intended to protect businesses from lawsuits by employees relating to their job-related injuries. It equally protects an injured worker by covering the costs of
- Injury-related healthcare expenses and medical bills
- A certain percentage of their lost wages
- Disability benefits
How it works
The basic claim procedure
As per the insurance rule, if workers come across a job-related injury, it is important for them to immediately report the same to their employer to avail of the insurance benefits. While the deadline for reporting and making a claim varies among states, typically it ranges between 72 hours to 2 years. Most states require reporting to be done within 30 days to begin the worker’s compensation claims process.
Being an employer, once an employee reports to you about his/her job-related injury, you need to follow the steps as stated:
- Once you come to know about the injury of the worker, first of all, assist the employee to get the required treatment.
- Now, your second job is to investigate thoroughly the accident. Make sure to document explaining what has happened and also figure out the potential safety issues. The investigation process may involve asking witnesses for reporting on the same and getting images.
- Your next step is to file a claim. Typically, you remain responsible to file a worker’s compensation claim with your worker’s compensation insurance provider. Equally, you will require to submit a company of the documentation to the state’s workers’ comp board.
- As soon as the worker’s claim is filed, the insurance company may either approve or disapprove it depending on certain factors. This is done after a necessary investigation by the insurance company wherein you may get involved to explain where and how the incident took place. The insurance will examine all necessary medical files as well as accidental reports.
What if the claim is denied?
In general, worker’s compensation insurers reject a claim for injuries:
- If it is the consequence of horseplay or fighting
- If it is self-inflicted
- Occurred during an employee commute to work
- It is found that the worker was intoxicated or under influence of drugs or alcohol etc.
Under such circumstances, the injured worker can hire someone such as Michael Saltzstein who is specialized in worker’s compensation cases for more than decades. Typically, this follows an appeal involving an administrative hearing.
What if the claim got approved?
Whereas the compensation claim got approval, the insurer will bear the cost for all l injury-linked medical expenses If the worker is found unfit to work, the insurer will pay a part of the wages of the injured worker on a weekly basis and benefit. In addition, the insurer will pay a temporary disability benefit as much as 2/3rd part of the regular pay of the employee. The benefit of temporary total disability comes to an end, once the employee returns to the workplace.