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Workers’ Compensation Facts to Know When Buying Coverage
by Medical Review MEDICAL RECORD REVIEWSWorkers’ compensation insurance is necessary for all businesses to provide coverage to employees injured or taken ill while on the job. The benefits are given only after the genuineness of the injury is established by reviewing the relevant medical records preferably with the support of a medical chart review company. Legislation related to workers’ compensation benefits have changed considerably over the years and vary from one state to another. Employers purchasing workers’ compensation insurance have to focus on containing costs while keeping their employees safe and happy.
The costs associated with workers’ compensation vary widely from state to state, and according to the National Academy of Social Insurance, it ranges from $0.75 in Texas to $2.74 in Alaska per $100 in employee wages. The cost is also determined by the type of work an employee performs, with the cost increasing with more risk related to the job. The Bureau of Labor Statistics reported that in 2018 the cost for sales and office professionals was $0.22 per hour or 0.9% of overall compensation whereas the coverage for natural resources,constructionand maintenance jobs was $1.16 per hour, or 3.2 percent of overall compensation. Typically, the cost is based on the classification by the National Council on Compensation Insurance (NCCI), which is an independent council that identified 700 “class codes” signifying the risks of various job types.
Workers’ compensation insurance is different from group health insurance. It is state-regulated coverage for employees injured or fallen sick on the job whereas group health insurance is coverage for workers for preventative care and medical expenses for injuries/illnesses not originating from workplace activities. Most health insurers exclude coverage for ailments covered by workers’ compensation insurance.
Here are some important facts to know about workers’ compensation.
- State-regulated workers’ compensation insurance depends entirely on the number of workers at the workplace and the particular industry niche. For example, Georgia’s workers’ compensation requires insurance if an employer has more than 3 employees at any workplace. In California, all employers and all work situations require workers’ compensation coverage.
- The federal government administers workers’ compensation for specific groups of employees including federal workers, longshore workers, and coal miners. Employees do not contribute to workers’ compensation premiums.
- Workers’ compensation claims cover lost wages, medical expenses and disabilities. It does not cover pain and suffering. A personal injury lawsuit can financially compensate for pain and suffering arising from an accident.
- Worker’ compensation will not cover some workplace injuries that are outside the scope of the program. These include self-inflicted injury, injury that happened when a crime was committed, when the employee violated company policy, or was not on the job when the event happened.
- An injured worker can choose to file a lawsuit against the employer (for a reckless or intentional act) that resulted in the injury, only if he/she forgoes his/her right to workers’ compensation. In other words, if a person collects workers’ compensation benefits, he or she gives up the right to file a lawsuit.
- Employers cannot discriminate against an employee for filing a claim. Federal and state laws prohibit such kind of discrimination and retaliation.
- Employers and employees sometimes indulge in workers’ compensation fraud. Employers do so to reduce premiums – they may mis-classify employees as non-employees or owners; they may also under-report the number of employees. Workers may commit fraud by falsely claiming an injury. Healthcare providers may also contribute to fraud by claiming fees for non-existent medical treatments/services.Any kind of fraud will lead to heavy fines and penalties.
- Workers’ compensation benefits may be paid even after returning to work. This is in cases such as permanent partial disability and the worker is earning less than his/her pre-injury paycheck.
- Workers’ compensation benefits are not taxable; benefits including payments made to survivors of a deceased worker are not taxed.
- Injured workers may be able to collect social security benefits as well as workers’ compensation at the same time. The social security benefits may be taxed or reduced in this regard.
An important thing to understand in connection with workers’ compensation insurance is that advances in technology will impact it considerably. Workers’ compensation underwriters will be able to complete medical chart reviews and review of medical bills at a remarkable speed and predict injury risks. AI and Machine Learning can review huge volumes of data within seconds. This will bring advantages such as better prediction of workplace injuries, better risk prevention, more accurate underwriting and faster claims processing.
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Created on Oct 25th 2019 04:27. Viewed 512 times.
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