Workers’ compensation insurance covers medical and financial costs from work-related injuries or illnesses. It also offers financial support to help employees maintain a stable income while they recover from their injuries.
Comorbidities — the presence of an additional, independent medical condition that co-occurs with another — add to the complexity of workers’ comp claims and impact recovery times. They may also increase costs for employers.
Health Care
Workers’ compensation benefits aim to ensure injured employees get the care they need to recover. This includes salary replacement for lost wages, medical expenses, and retraining costs. It also covers death benefits for families who lose a loved one due to a work-related injury.
All states except Texas require employers to carry employee workers’ compensation insurance. The states write their workers’ comp laws but share many standard features. These include a tradeoff: Employees waive the right to sue their employer in exchange for limited wage-replacement payments and coverage of their medical expenses.
Workers’ compensation plans typically provide for weekly payments instead of lost income, reimbursement or payment of medical and like expenses (functioning as a form of health insurance), and benefits payable to dependents of an employee killed due to a work-related injury. General damages for pain and suffering, punitive damage awards for worker negligence, and benefits based on an employer’s payroll are not available under these plans.
A recent trend in workers’ compensation is a rise in so-called mega claims, defined as those with $3 million or more in incurred losses. The increase in these large-loss claims is primarily attributed to severe injuries caused by motor vehicle accidents, serious falls, and struck-by incidents.
In response, workers’ comp insurers are accelerating the adoption of telemedicine offerings that allow for virtual evaluation and diagnosis of injuries. These can be paired with in-person treatment to speed recovery times.
Loss of Earnings
Workers’ compensation covers the cost of medical care related to a work-related injury. In some cases, it also pays for a portion of the employee’s lost wages after a specified period. It may also provide death benefits to families of employees who die from a work-related illness or accident. Studies have found that effective workers’ compensation programs can reduce workplace injuries and associated costs.
For example, a program in one metropolitan surgical hospital found that the number of worker’s compensation injuries dropped by 56% and that the time away from work after an injury was cut by 68%. Doctors approved by the workers’ compensation board often decide when an injured worker can return to work. Usually, the doctor will recommend light-duty or complete-duty work.
When a doctor is unsure whether an injured employee can return to work, they can file forms asking for a variance. Workers’ compensation is a public policy designed to protect all workers, regardless of the size and type of their employer.
Most states require all businesses to carry workers’ comp insurance, including small business coverage for operations with just a few employees. In addition, most states have laws requiring workers’ comp for certain illnesses and accidents that occur during the employee’s employment.
Death Benefits
From construction sites to office buildings, it’s almost inevitable that employees will sustain work-related injuries or illnesses. Unfortunately, some of these accidents or illnesses can be fatal.
Fortunately, workers’ compensation provides death benefits to help families cope with their loss. These benefits, which are paid in addition to medical bills and lost wages, may also cover funeral costs and other expenses.
A worker’s death benefits are based on a percentage of the deceased employee’s average weekly wage. Typically, this is two-thirds of the average weekly wage, but minimum and maximum amounts are set by state law.
The benefit amount is then divided among the surviving spouse, children, or other eligible family members to receive the payments. It’s common for these cases to contain a lot of legal issues, and it’s usually best to have the assistance of a workers’ compensation attorney in such instances. In most states, an injury must be sustained during a person’s job duties or while performing a work-related task for their employer.
There are some exceptions to this rule, however. Injuries or illnesses that occur outside of the workplace, such as a car accident, may still be covered by workers’ comp. In such cases, a person may qualify for workers’ compensation coverage if it can be proven that the accident occurred due to their employment.
Counseling
Injured employees may need guidance and support as they recover. Workers’ compensation often covers counseling for injured workers to help them cope with their injury or illness’s physical, emotional, and financial effects. It may also cover psychological counseling if the injury or illness is expected to have a lasting impact on their life and career.
In addition, workers’ compensation often pays temporary wage replacement for time off while an employee recovers from a job-related injury or illness. Wage replacement is usually about two-thirds of an employee’s average salary. Injured employees must be approved for the benefit of doctors designated by the workers’ comp system or employer.
Doctors can also decide when an injured worker can return to work at limited duties or reduced pay. Employers must communicate with their employees about reporting work-related injuries or illnesses. This communication can be included in an employee handbook, conveyed during orientation, posted on bulletin boards, and communicated regularly during safety reviews.
Employees who feel valued and that their employer cares about them will generally be more eager to return to work as soon as they are medically able. Workers’ compensation is susceptible to insurance fraud, and it can be difficult for injured employees to receive the benefits they deserve. Having solid legal representation is crucial in these cases.
