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Important Facts to Know about the Workers’ Compensation Program

Workers’ compensation is a beneficial program for workers administered at the state level in all fifty states, Puerto Rico, the District of Columbia, and the U.S. Virgin Islands with each state having their own program. The federal government has their own program for their employees. The benefits are paid to workers injured on the job and those who have acquired a work-associated illness or health condition. Since medical records are a crucial factor when determining benefits, medical review services have an important role to play. Workers’ compensation is designed to provide coverage for injured workers’ medical costs, and lost wages. It may also cover death and funeral benefits if required. A three to seven-day waiting period is involved before the benefits begin.

Important Facts to Know about the Workers' Compensation Program

What are the types of workers’ compensation benefits?

  • Temporary total disability: It will cover around two-thirds of a worker’s pre-injury wages until the worker returns to work. When the worker resumes work, the benefits end.
  • Temporary partial disability: Workers who return to work with reduced responsibilities on account of their injury and a lower salary receive this type of benefit. It helps make up for the loss in wages.
  • Permanent total disability: This benefit is paid to a worker, whose injury results in permanent impairment or the worker has reached his/her maximum for medical improvement for the injury. Only few workers’ comp claims result in permanent total disability benefits.
  • Permanent partial disability: These benefits are usually limited to a particular period or total dollar limit. It is paid to an employee who has permanent impairment that does not completely limit his or her ability to work. It is paid until the worker has achieved maximum medical improvement.
  • Medical benefits: Only medical benefits are paid to workers whose cases do not extend beyond the 3 to 7 day waiting period.
  • Death benefits: Paid to the dependents of a deceased worker, this compensation is based on a formula that calculates the worker’s earnings and the number of dependents who are determined to be eligible survivors.

To determine eligibility for any of the above compensation, medical chart reviews constitute an important preliminary step.

What are the eligibility criteria to file a claim?

  • The employee must be working in the company where the claim will be filed.
  • The employer must have a workers’ compensation insurance program in place for their employees.
  • The injury or illness must be a work-related one.
  • The worker must report the injury and file a claim in compliance with the state’s deadlines for doing so.

Now, let us look at some of the other vital things workers must know regarding workers’ compensation. When an injury occurs, notify the employer at the earliest and this should be in keeping with the time frame of the particular state. Early reporting is advantageous because the worker will receive medical treatment at the earliest and the employer can take steps to address any safety issues that exist in the organization. Here are some other pointers:

  • The workers’ compensation claim must be filed on a timely basis.
  • The employee should spend some quality time reviewing the important information regarding his/her rights, responsibilities, benefits and the support available. This information is usually sent to the employee by the claims examiner and the state workers’ compensation agency.
  • Make sure to communicate with the employer as well as the claims adjuster regarding the medical status.
  • Follow the doctor’s orders scrupulously.
  • Be honest and frank when talking about the injury as well as any prior injuries or accidents to the affected body parts.
  • Do not stop medical treatment before being released.
  • Take care not to take treatment from unauthorized providers in states where the employer can manage medical care.
  • Return to work as soon as possible and resume a productive lifestyle.

Workplace safety is a priority for all types of industries and worker injuries tend to be more in certain sectors such as construction, compared to others. Injuries and illnesses to workers result in unfavorable consequences to employee health as well as financial losses to companies.  Liberty Mutual figures show that U.S. companies lose more than a billion dollars per week due to workplace injuries. Careful review of the injuries or illnesses and follow-up are vital to prevent fraud and to make sure that compensation is paid to deserving claimants. Providers of medical record review for attorneys play a significant role in the industry ensuring dedicated medical review solutions that are so important to determine workers’ compensation benefits.

 

     

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