How An Employee’s Workers Comp Claim Affects the Employer

Workmans Comp Claim
If you’re an injured worker, you may want to know how a workers comp claim affects the employer. According to the Department of Labor, most employers anticipate workers compensation claims and create an efficient internal process to handle them.

However, it’s also important to know that employers pay workers compensation insurance premiums. Even if the company has few workers compensation claims, the employer’s premiums are likely to rise over time.

If an employer retaliates against the injured worker for submitting a workers compensation claim, the dispute may arise because these claims are costly to the employer. Both direct costs, such as the amount paid to settle the claim, and indirect costs, such as the rising cost of workers comp insurance premiums, are expenses that hit the business’s bottom line.

Workers Compensation Insurance Premiums

A business with a greater number of workers compensation claim is likely to pay higher insurance premiums. The workers comp policy premiums rise when a larger than anticipated number of workers file for workers comp benefits or when one or more employees have expensive claims to cover.

Insurers and employers frequently engage investigators to monitor those workers who’ve filed for workers comp benefits.

Employer Perspective and Bias

Most employers accept workers comp claims as a cost of doing business, but a small numberof employers resist belief about workers’ injuries after an accident. Let’s say a worker experiences cumulative trauma over a longer period and starts to experience acute pain. She can’t work and presents a report to the employer based on a doctor’s findings. The doctor’s report explains that the employee’s injuries are job-related.

The employer may express disbelief about the employee’s workers compensation claim or react with outrage.

Unfortunately, repetitive stress injuries happen to the employee over time. A cashier with carpal tunnel syndrome used the hands, wrists, and arms to scan grocery items on a conveyer belt for more than 25 years. The employer’s perspective was one of disbelief because the worker’s condition seemed to appear suddenly.

The employer’s perspective is biased. After discussing the employee’s workers comp claim with an attorney, he learns that repetitive stress injuries aren’t wholly verifiable by the medical examiner and that imaging, x-rays, or nerve conduction studies can’t confirm or deny the worker’s disability.

When the employer expresses a biased perspective against the employee’s workers comp claim, it’s important for the employee to seek legal counsel. Because the employee has 25 years’ tenure with the company and a record of good attendance, it’s important for the employer to know that some medical conditions are challenging to verify through objective means.

Reasons for an Employer or Insurer to Deny Workers Comp Claims

Employers and their insurers aren’t required to pay all workers comp claims, wholly or in part. If the employer denies the employee’s workers comp claim, it must explain the reason for denial in writing. Reasons provided for denying an employee’s workers comp claim include:

  • The employee’s injury wasn’t serious.
  • The employee’s injury didn’t happen within the employment environment or in an extended scope of the employee’s responsibilities to the employer, such as when he or she traveled for business or ran errands for the employer.
  • The employee’s injury doesn’t require medical treatment.
  • The employee’s injury doesn’t necessitate time away from work.

How Employers Fight Employees’ Workers Comp Benefits Claims

If the employee notifies the employer that he or she plans to file a workers compensation claim, it’s the employer’s responsibility to provide the necessary forms and paperwork needed to file the workers comp claim within 24 hours in most states. The employee then prepares the workers comp claim paperwork and submits it.

The employer or its insurer then reviews the workers comp claim. If the claim is denied, it’s the employer’s responsibility to promptly respond to the claim and provide a reason for the denial.

At that point, the employee can call and/or write a response to the workers compensation insurer. If communication with the insurer doesn’t resolve the employee’s problem, the employee can engage a workers compensation lawyer or request a denial of benefits hearing with the state workers compensation board.

Some employers take the opportunity to discuss the workers comp claim, work-related illness or injury, and medical treatment costs at that time. It may make good financial sense—and create a sense of good will between the employer and employee—to arrive at a mutually beneficial solution.

For instance, if the worker’s injury is temporary and the medical costs aren’t extensive, the employer might offer to directly pay the employee’s medical costs during his or her period of recovery.

Employers and the Bottom Line

Employers must proactively manage workers comp claim. It’s a fact that employees may be sick or injured on the job. When a job-related incident occurs, it’s the employee’s right to file a workers compensation claim. If the insurer denies the worker’s comp claim, the employee must consider the next steps.

If the employee makes the decision to fight the insurer after a claim denial, it may make sense to engage a workers comp lawyer. With legal support, questions about the employer’s bias about the worker’s medical condition or disability are ultimately irrelevant. If the employee has a legitimate work-related injury or becomes ill over time because of work conditions, he or she has the right to make a workers comp claim.

The employee shouldn’t worry about the employer’s perspective or whether the employer plans to carry a long-term grudge about the claim. The employer’s perspective is most likely directed at the bottom line of the business and not on the workers comp claim outcome.

Most employers understand that workers comp claims occur. If they’re focused on long-term business and organizational growth, the business wants to support the needs of the injured worker without incurring higher workers comp premium costs and indirect expenses.

All told, the workers compensation system protects both the employer and employee when an accident, injury, or illness occurs. In filing a workers comp claim for benefits, the employee waives the right to bring litigation against the employer.