When an Employee Applies for Workers’ Compensation

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The vast majority of employers around the United States are required to carry workers’ compensation insurance. This critical form of support is available to employees who are injured on the job or in the course of carrying out their job. Workers’ compensation insurance also gives employers peace of mind if an employee does indeed get injured because the employee will pursue workers’ compensation benefits rather than suing the employer outright.

At some point or another, most employers will have to deal with an employee filing a workers’ compensation claim. While employers in certain industries may have higher rates of claim filings, all employers may be exposed to the challenges of following a workers’ comp claim through the process from the time an employee is injured all the way through an approval or denial.

However, human resources professionals, managers and, company owners should all be aware of how the workers’ compensation process works so that they know what to expect and can avoid many of the common pitfalls facing employers. For example, an individual who files a workers’ compensation claim has protection from retaliation and other discriminatory practices in the workplace just by filing the claim.

That makes it all the more important for employers to be aware of some of the activities or behaviors that could be misinterpreted as retaliation, forming the basis for an additional lawsuit against the employer in question.

Understanding the Benefits of Workers’ Compensation Law

An injured employee is eligible to collect benefits through a program for an employer who carries workers’ compensation insurance. It’s important to realize that workers’ compensation insurance is not just there for employees; there are also many valuable protections for employers as well. There are limits as to how much financial compensation an employee is entitled to, and a worker is also prohibited from filing litigation which can save the employer from the time and expense of fighting a lawsuit. If there are other parties involved, however, the employee may still be eligible to file a civil suit against a third party. This could ultimately end up restoring the amounts that the employer has paid out to the employee for dealing with the situation. Work-related injuries can affect anyone, but only employees of a company can obtain workers’ compensation benefits. Independent contractors, for example, do not qualify. Agricultural workers, seasonal employees or domestic workers may not be eligible, but the exclusions vary, so it’s important for an employer to sit down with their human resources professional to identify exactly which of their workers are eligible to receive workers’ compensation benefits.

Work-Related Injury Classifications Can Be Difficult

Unfortunately, state laws are often vague or inconsistent about what constitutes a work-related injury. However, in general, a work-related injury or illness must be associated with the worker’s job. Certain accidents at work-sponsored events, in break rooms or in a vehicle while traveling for company purposes can also be covered. The laws may apply even if the employee is injured due to carelessness. However, accidents related to purposeful assault behavior or intoxication may not be covered. When an employee is injured on company premises during work hours, a workers’ compensation claim is likely to be successful. Workers’ compensation benefits can also be available if an employee was injured as a result of work-related strain or stress.

Employers should be mindful of the fact that injuries could be classified as physical or mental. A hostile work environment, for example, could contribute to psychological stress and justify a workers’ compensation claim. In these types of allegations in which the employee may be claiming that the employer knew about the situation and failed to correct it, it is especially important for documentation and reference to the employee handbook to be consistent. This means that if the employee pursues a stress-related condition through workers’ compensation benefits and also files a lawsuit due to a hostile work environment, that the employer is thoroughly protected and has documentation and evidence on their side.

What Employers Cannot Do

It is always important to take any claim regarding workers’ compensation or an injury in or around the workplace very seriously. It is not the employer’s or human resources manager’s job to determine whether an injury occurred or should be covered by workers’ compensation; that is determined by the insurance company. The employer should do everything possible to document how the accident occurred and how he or she responded in the event that this is questioned down the road. Employers cannot deny employees appropriate medical care if an injury was suffered at work. When an injured employee is eligible to come back to work, the employer must take him or her back. One of the most important things to keep in mind for human resource managers and employers is that an employer cannot retaliate against an employee in any fashion for filing a workers’ compensation claim or thinking about filing a workers’ compensation claim.

An employer who attempts to demote, reduce the pay, or terminate an employee because of a workers’ compensation claim opens themselves up to litigation brought forth by the employee. It is very important to be careful in the words that are used in written and verbal communication following a workers’ compensation claim. Being reasonable and accommodating with the employee and documenting all of the steps taken and why they were taken can help to support an employer in the event that the employee comes back with allegations of retaliatory or negative behavior.

These situations can be especially problematic if the company has already dealt with the temporary or permanent loss of the employee in question because of a severe injury. It is important for employers to articulate what employees must do when filing a workers’ compensation claim so that there is not an opportunity for confusion when an accident happens. Being respectful and helping the employee with the workers’ compensation claim can go a long way.