Workers Compensation

When an employee is injured on the job, the way that they would access medical care for a work related injury is totally different from the way they would access medical care for a non-work related injury. 

For example…

Jane Z. slips and falls on the stairway at work and injures her right shoulder. She is still able to work, but she is in pain. Her plan was to go see her primary care physician on the way home from work, but she is growing more concerned and not really sure what she should do. Her injury is work related yet she is worried about filing a work comp claim.

What should Jane do?

Jane should notify her employer about the injury. She would then be been asked to file a claim that provides a detailed account of the accident, including:

  • When the injury occurred.
  • What part of the body is injured.
  • Date and time of injury.
  • How it happened.
  • Where it happened.
  • Any conditions that may have contributed to the injury, slippery, wet, icy etc.

The employer would then refer her to a medical provider to be checked out. The provider would interviewed her, preform a full examination and detail her injuries. Depending on her injuries, she may be released to return to work unrestricted, with restrictions, or in some cases, the condition may be severe enough that she may have been unable to return to work. She then be managed by a Workers Compensation approved provider until released from care.

Workers Compensation guarantees:

  • Replacement of loss wages
  • Medical care
  • Rehabilitation
  • Other benefits

What is Workers Compensation?

Workers Compensation is required by each state and is insurance coverage that all employers are required to purchase. The purpose is to provide coverage to employees that become ill or injured as a result of their job.

Employers pay premiums to a state fund and claims are handled by the insurance carrier. Each state administers its own program. Claims are filed by the employer to the insurance carrier, who then files with the state.

Workers can receive lost wages and coverage for medical care, dismemberment, disability and death. Workers can go to the assigned doctor or they can request to have an Independent Medical Exam (IME) performed by a doctor of their choice. The doctor will examine the sick or injured worker to determine the condition, the degree of disability and if and when the worker can return to work. Workers compensation plans pay primary to any other health plan. 

So why does this matter?

It matters because seeing a patient that has an open workers compensation case, unless the provider has clear authorization to treat, may result in nonpayment of the claim.

Most group plans do not provide coverage for any work related illness or injury.

Patients that seek treatment for some specific conditions or complaints such as back pain, accidents and injuries should be queried about how the condition occurred. Sometimes a patient will seek care from a non-work approved provider because they are reluctant to file a claim for fear of retaliation or loss of job.

Every state has a Worker Compensation Board with detailed information that can be found online. Patients with unreported injuries should be referred to the website for help with the process.


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