How to Handle a Workers’ Compensation Claim

(10-12 minute read)

When an employee suffers a covered injury at work they can make a claim for workers’ compensation benefits if the employer offers workers’ compensation insurance.  The process for dealing with a claim is complex and involves a number of parties, including the employee, employer, insurance company, doctors, and the state workers’ compensation board.

Because workers’ compensation laws are governed by the state, rules surrounding claims tend to vary. For illustration purposes, we will refer to the state of Michigan.

Overview of the Claim-Filing Process

As soon as an employee suffers a work-related incident, they should report it to a supervisor because the state allots a limited timeframe for reporting the incident and collecting benefits. The statute of limitations differs by state.

In Michigan, employees must report the injury to their employer within 90 days or they may lose the right to collect benefits—which include payments for medical expenses and lost wages. To receive benefits, the employee must make a claim for workers’ compensation to the employer or the Michigan Workers’ Compensation Agency (WCA) within two years of discovering the job-related illness. Notice of the injury can be given to the employer orally or in writing. But, as a precautionary measure, employers should request written notification.

For the first 28 days after the injury, the employer can choose which physician or medical facility the employee should go to for treatment. After receiving the first 28 days of treatment, the employee can go to his or her own physician or medical facility—but he or she must give the employer the name of the medical provider.

Upon receiving notification of the injury, the employer should report the incident to the WCA via Form WC-100 and to its workers’ compensation insurance carrier. Note that most states allow employers to purchase workers’ compensation through a state-run program or private insurance company—or to self-insure, if the employer is large enough.

In Michigan, either the employer or employee may file a workers’ compensation claim with the WCA. If the employer does not file the claim, the employee can do so by submitting an accident and illness report/claim form to the WCA.

Benefits Determination

The insurer decides whether the employee qualifies for workers’ compensation benefits. Therefore, the employer should ensure the incident is properly investigated, documented and reported to the insurance provider. In Michigan, the insurer must notify the WCA once payments have begun to the injured employee. The initial payment must be made within 14 days of the date that notice of the injury was received. Weekly benefits are approximately 80 percent of the injured worker’s after-tax wages.

Disputing a Workers’ Compensation Claim

Employers have the right to dispute a workers’ compensation claim. However, the Michigan Economic Development Corporation (MEDC) states that “80 percent of claims for workers’ compensation benefits are paid without any dispute over their legitimacy.” If you happen to disagree with a claim, contact your state’s workers’ compensation agency for details on contesting a claim.

In Michigan, disputed claims have been resolved or discarded through various means, including mediation, when a mediator from the WCA meets with the parties in the dispute and tries to reach a middle ground. According to the MEDC, if the case cannot be settled via mediation, it is then turned over to the Board of Magistrates and a formal hearing is scheduled. Based on testimonies given at the hearing, the magistrate either grants or denies the claim. The magistrate’s decision can be appealed to a workers’ compensation appellate commission. The appellate commission’s decision can be appealed to the state Court of Appeals, and eventually to the state Supreme Court.

Do You Need Legal Representation?

Workers’ compensation claims can often be resolved without the assistance of an attorney. However, consider seeking legal counsel if:

  • The employee appeals the claim decision, which may happen if the claim is denied.
  • The employee files a lawsuit against you in civil court. Typically, employers who offer workers’ compensation cannot be sued by employees for work-related injuries. In limited cases, however, employees can file a lawsuit.
  • You lack the ability to capably represent yourself.

Cost-Cutting Strategies

Workers’ compensation costs are a massive concern for many employers, particularly those in high-risk industries. Consequently, employers should devise prevention strategies to reduce workers’ compensation claims. You might, for example, provide ongoing safety training to reinforce the importance of being careful on the job.

You can also apply the process of “ergonomics,” which involves designing the job to fit the worker’s body rather than forcing the worker’s body to match the job. This practice of adapting work stations, tools and equipment to fit the worker can help reduce physical stress on the employee’s body and musculoskeletal disorders.

On a final note, employers should remember that when employees get hurt at work and subsequently file a workers’ compensation claim they may also worry about losing their job—which can impede their rehabilitation. Employers can help speed up the recovery process by staying in contact with the injured worker.

For additional information on how to handle these claims, and strategies for preventing workplace injuries, reach out to us today.

 

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Date

October 4, 2018

Author

AXIOS HR

Category

Article Attraction Compliance