What Does Worker’s Compensation Insurance Cover?

Oct 17, 2019 | Business Insurance

Workers Compensation Insurance Coverage

Since each state has its own laws regarding Worker’s Compensation Insurance coverage, it’s important to know what those laws are.  Though most states require a business owner to carry workers compensation insurance for all W2 employees, there are a few states where this coverage is not required by law, however, the business owner can still be held liable for injuries or illness an employee sustains while on the job. Worker’s compensation will cover the cost incurred, to get an employee back on their feet after a work-related illness or injury. In the event of a permanent disability or even death, workers compensation coverage is there to not only help the employee and their family, but it is there to help the business owner as well so that they can keep their operations going while having the peace of mind that their valued employee is being taken care of.

Deadlines and Validation of Injuries

It is important to know that each state also has its own rule as to how long an employer can wait to file a workplace injury/illness claim. Depending on the State, the deadline may range from 30-90 days after the injury/illness happened. The initial medical evaluation should be done by the approved medical provider that the employer chose. If the injured worker fails to notify their employer or the employer fails to file the claim on time, they may lose the right to continue the claim and the employer could end up paying out of their pocket for the expenses that are accrued.

* In the event of an emergency, it is always best to get to the quickest/closest medical provider first, then notify the employer as soon as possible.

Valid injuries:

  • When an injury or accident occurs while on the job
  • Driving or traveling for business reasons. Like Business trips. 
  • Accidents caused by natural disasters.
  • Illness or injury caused by exposure to toxic chemicals from work.
  • Injuries from workplace violence.

Invalid Injuries:

  • If the injury is caused by a fight started by the employee who’s filing the claim as it will be considered a self-inflicted injury.
  • When the claim was made after the employee resigned.
  • No one witnessed what happened. No recordings or videos.
  • The employee couldn’t meet the State’s deadline for reporting the injury and filing a Worker’s Compensation Claim.

Mental Health

It is also important to know that not only are physical injuries covered, mental health issues can also be covered.

It is common knowledge that most workplace injuries are physical and can be seen and treated as necessary. For instance, while working, a large piece of metal suddenly falls and injures an employee. The employee’s physical needs will be addressed as needed, but what about the trauma as a result of the accident?

Mental health is just as important as physical injuries and should not be neglected.  PTSD (Post Traumatic Stress Disorder) may occur after a tragic incident. This too must be treated and taken care of.

How to determine if the work-related stress is considered a PTSD and can be compensated?

Stress is something that everyone experiences from time to time. However, the stress that is felt after a traumatic accident, may not be normal stress any longer. It could be that the employee is suffering from *PTSD. This is a very serious condition that will need to be treated.

Stress after an incident cannot be considered PTSD unless:

  • The symptoms of the stress must last or start at least a month or more after the incident or injury happened.
  • Must be diagnosed by a psychiatrist or psychologist.

Symptoms that last in less than a month cannot be considered PTSD. However, even if the symptoms don’t meet the required time frame, help should still be sought in order to prevent anxiety from worsening and potentially turning into PTSD.

*Some States have regulations regarding stress as a compensable worker’s compensation claim. Always, check the laws of your state.

Coverages available for a valid claim

Short Term and Long-Term Care

Short term care includes immediate needs after an injury or accident. If the damage is not severe, the employee will receive regular medication, check-ups, and x-rays as needed and ordered by a licensed medical doctor.

Long term care is available when the condition calls for more time to recover.  This may include both medical and therapeutic care. How long and how often the therapy is needed will depend on the severity of the condition.

Permanent disability

Some cases may lead to a permanent disability. However, most worker’s compensation plans will provide coverage in the event of a permanent disability.  Vocational Rehabilitation may also be available if the injury/illness is deemed permanent and the employee is no longer able to perform, the same type of work, as before the injury/illness occurred. This coverage may help the employee to remain at the same company in a different role or enable the employee to seek employment elsewhere.

Lost Wages

Losing wages from the time off work is can be devastating for the employee and their family. Most worker’s compensation plans will pay an injured worker approximately 66% of their normal weekly wages. The amount of the wage benefit, that an employee may get, will depend on the amount they earned the previous 52 weeks, gross.  

Currently, it is more important than ever to be sure that your business is covered if an employee is injured or becomes sick while on the job. At Advantage Insurance Solutions, we take pride in our ability to work with business owners in order to customize and insurance plan that will meet the unique needs of your business. Our insurance professionals will search dozens of carriers to make sure that your business has the best coverages at rates that will fit your budget.

Contact us today and let’s talk about how we can help you minimize the financial risks related to running your business.