It operates under a no-fault system, allowing medical care and salary replacement without litigation. The majority of states mandate that companies carry this insurance. For more information about how it works, Insurance Business has compiled this comprehensive guide for business owners and insurance professionals alike.
What is Workers’ Compensation?
Most states have laws defining specific kinds of medical care and financial benefits injured workers are eligible to receive. These benefits are structured differently in different states but generally include the following:
- Weekly payments to replace lost wages (functioning as disability insurance).
- Payment of past and future medical bills.
- A death benefit for families.
Injuries to the brain, lungs, or spine are considered “non-schedule injuries.” They can entitle a worker to benefits that last between 225 weeks (for a 15% degree of disability) and 525 weeks (for a 95% degree of disability). Injuries to the hands, feet, eyes, or hearing – scheduled injuries – entitle a worker to compensation that runs from 52 weeks to life.
Injured employees must have a doctor evaluate their condition and determine the extent of their permanent impairment. If an injured employee and employer disagree with the doctor’s assessment, they can ask for a second opinion by requesting a Qualified Medical Evaluator (QME). The QME will then select one of three doctors to perform the evaluation. If the parties can’t agree on which physician to choose, they can strike off one of the physicians from the list and select the third one.
How Do I File a Claim?
If you get hurt or sick at work, follow the rules of your state’s workers compensation in Hawaii system. That means immediately reporting an injury or illness and filling out forms to file a claim with your employer’s insurance company. You must also seek medical care. A workers’ comp insurer will check to see if the doctor follows your treatment plan, including any restrictions. It will also notify you of its decision on your claim within a specific time frame. State laws differ on how long you have to wait for a decision on the status of your claim.
Usually, you must report an accident to your employer as soon as possible—and no later than 90 days after the date of the injury. It is best to inform the injury in writing to your boss, foreman, supervisor, or another person of authority.
Being injured on the job can throw your entire life into disarray. You suddenly have medical bills, concerns about being able to provide for your family, and the possibility of not being able to work again. This is why having strong workers’ compensation attorneys is so important – especially if your claim is denied.
You may have to undergo tests and expert examinations before receiving benefits. If your insurance company suspects fraud, it may send a private investigator to examine your case. During that process, it is vital to have the assistance of an experienced workers’ compensation attorney to protect your rights. An attorney can help in many ways, from assembling evidence that supports your claim to negotiating with the insurance company and representing you at hearings.
What Should I Do If I’m Injured?
A worker injured on the job should report it to their employer or supervisor immediately. They should also seek immediate medical attention. This can be done at a company medical facility, walk-in clinic, or the emergency room at a hospital. Workers should see a doctor within seven days if the injury is serious. Employees can choose their physician, but their employer may request they visit a provider on their insurance plan.
After an injury, workers should keep track of their expenses, including travel to medical appointments (whether they use their car or pay a taxi or public transportation). They should also keep track of any time they miss work because of the injury. This is important because the workers’ compensation benefits can help cover lost wages.
Workers must make all their medical appointments. If they skip appointments, investigators might suspect fraud. If they cannot attend an appointment due to an illness or injury, they should call the doctor as soon as possible and explain the situation.
In addition, workers should file a workers’ compensation claim as soon as possible. Every state has a statute of limitations for filing workers’ comp claims, and waiting too long can cost employees money and the ability to get the medical treatment they need. Almost every business in the United States must carry workers’ compensation insurance (or be covered by state-run funds) as part of a 70-year-old federal law. In most states, companies purchase their coverage through private insurers or, for large businesses, directly from the state’s fund. Small business owners and sole proprietors can buy their coverage through a top-rated provider with experience with this type of policy and who knows how to handle claims best.
