With the release of our Recovery+ program, we’ve gained valuable insights from our injured workers going through rehabilitation treatment. As part of our direct, text-based engagement, we’re not only checking in with them on their care plan, often simply asking “How are you doing?” but, before discharge, we ask for feedback on their overall work comp experience. One of the common answers we receive is: that the workers’ compensation experience is confusing and overwhelming.
Yes, we know.
This is the exact reason why we develop and deploy educational content to help injured workers understand and navigate their workers’ compensation experience.
Being an expert in both the workers’ compensation industry and the PT/OT space is important to us, our payers, our partners, and our injured workers. Below is just a sample of the type of content we share with injured workers throughout their plan of care to help create a better experience.
How Does Workers’ Compensation Work?
Workers’ compensation is a crucial aspect of employee benefits that ensures workers are protected in the event of a workplace injury or illness. Understanding how it works can help employers and employees navigate the process smoothly and ensure everyone gets the support they need. Here’s a quick rundown of what workers’ compensation encompasses, its benefits, and more.
What is Workers’ Compensation?
In short, workers’ compensation is a form of insurance that provides wage replacement and medical benefits to employees who are injured on the job or develop a work-related illness. This system is designed to protect both parties, offering financial assistance to the injured worker while limiting costly litigation for employers.
Who Requires Workers’ Compensation?
In most regions, workers’ compensation is a legal requirement for businesses that have employees. The specific requirements can vary by state and industry, but generally, any business with one or more employees needs to carry workers’ compensation insurance. This ensures that employees are covered in the event of an injury and that employers comply with legal obligations.
What are the Benefits of Workers’ Compensation?
Workers’ compensation provides several key benefits, including:
- Medical Coverage: All necessary medical treatments related to the injury or illness are covered, including doctor visits, medications, surgeries, and rehabilitation.
- Survivor Benefits: In the event of losing a loved one to a work-related injury or illness, monetary support is provided through death benefits.
- Wage Replacement: Employees receive a portion of their wages when they cannot work due to injury or illness. This typically is 66% of their regular take-home pay.
- Disability Benefits: If the injury leads to temporary or permanent disability, workers’ compensation provides additional financial support based on the severity and duration of the disability.
- Vocational Rehabilitation: Support and training are provided to help injured workers return to the workforce, even if a career or industry change is necessary due to their injuries.
What happens when an injury occurs at work – triggering a workers’ compensation claim?
The claims process is straightforward but must be followed meticulously to ensure that benefits are received promptly.
Employee Reports Their Work Injury Immediately
The first step is for the employee to immediately report their injury to the employer. Timely reporting is essential for documentation and medical management, as delays could risk claim denial.
Employee Seeks Medical Treatment
After reporting the injury, the employee should seek medical treatment immediately. In some cases, the employer may require the employee to visit a specific doctor or medical facility. Some states and insurers require that employees receive non-emergency treatments from an in-network medical provider to receive benefits.
File the Claim with Your Insurance Provider
Once the injury is reported and medical treatment has begun, the employer must file a workers’ compensation claim with their insurance provider. This involves submitting necessary documentation, including the injury report and medical records.
Insurance Provider Approves or Denies Claim
The insurance provider will review the claim and either approve or deny it. If approved, the employee will start receiving benefits. If denied, the employee can appeal the decision.
Employee Begins a Return-to-Work Program
Once the employee has been medically cleared, they can begin a return-to-work program. These programs are designed to help workers transition back into the workforce, often with modified duties initially to accommodate their recovery.