What Does Worker’s Compensation Insurance Cover?

Jun 6, 2022 | Business Insurance

If you are an entrepreneur or business owner, you are most likely trying to find ways. Exploring other creative plans to generate more income and grow your business, especially during this difficult time. While it has proven to be a challenge, it is essential to secure all business necessities. This is both for your entrepreneurial ventures and all your employees, respectively. And one that shouldn’t be amiss and taken lightly is insurance that benefits both employer and employee. That is Worker’s Compensation Insurance. So, for starters, what does workers’ compensation cover?

While this is a system of collective liability, it isn’t a complete science and still has a bit of field to improve. It’s not only essential for both employers and employees to procure and insure themselves of Worker’s Compensation. But also identify its coverage as a benefit and a possible trade-off for a lucrative or cost-factor opportunity.

Workers’ Compensation Insurance Coverage

What does worker’ comp cover? Previously called “Workmen’s Compensation,” Worker’s Compensation Insurance coverage varies from State to State. Knowing and understanding the legislation, statutory rights, and regulations they were based on is also beneficial.

Since each State has its laws regarding Workers’ Compensation Insurance coverage, it’s essential 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 illnesses an employee sustains while on the job.

Worker’s compensation will cover the cost incurred. This is 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 they can keep their operations going while knowing that their valued employee is being cared for.

So if you run a business in an industrial, mechanical, electrical, construction, roads & railways, in another physically taxing and demanding field, you’d be much more secure to have your employees. Your whole company, for that matter, be insured with Worker’s Compensation.

What does Workers’ Comp cover?

You’re not only providing your employees with proper compensable work insurance. But possibly avoiding unnecessary expenses levied by statutory regulations of the states.

Similarly, if you are an employee or working in the industries above, you’ll do yourself much favor. Escape future damages that might prove irrevocable by being insured by Worker’s Compensation.

While these are all facts, it’s worth noting too that Worker’s Compensation Insurance doesn’t wholly guarantee an employee. Especially one injured, rendering him unfit to perform tasks required to protect. Keep his current position in the company. 

What else to note regarding Workers Comp Cover?

And some common remedies were made in the law (Differs from state jurisdiction) to safeguard employers by limiting their liabilities to their stakeholders. In which this case, are the employees. Some of these remedies are contributory negligence. This states that injury incurred, physical or mental, due to malpractice, inadequacy, and out-of-the-ordinary prudence is required to complete the job.

The other remedy is the “Fellow Servants Doctrine,” which renders the employer not liable for any damages that occur to his employees. And when the partial or leading cause of injury was by that of a peer or co-worker. The last of the so-called “unholy Trinity” of tort defenses is the assumption of risk. This permits the employer from having liability to an injured employee if the said worker sees it. And understands the dangers associated with the task but still voluntarily accepts the job. These are only some laws that both parties must be aware of.

While these things might sound troublesome, especially to the employees, they need not worry because an employer or company cannot just terminate. And strip a worker of his job just because his work-related injury deemed him incapable of performing the said job.

Workers Comp

That is gross discrimination and a blatant violation of labor law. If eligible, one can be granted a Wage-Loss Replacement (WLRP) or “Lost Wage Differential” benefit. This is an employer & employee agreement of a total amount of money given to an employee to compensate for the damages incurred and loss of a job or source of livelihood due to physical or mental incapacity.

This is why it is a must for both parties to make themselves aware of the validities of claims, the severity of injuries, cost coverage, and deadlines of a Worker’s Compensation Insurance.

Deadlines and Validation of Injuries

It is essential to know that each State also has rules regarding how long an employer can wait to file a workplace injury or illness claim. Depending on the State, the deadline may range from 30-90 days after the injury or illness. 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 an emergency, getting to the quickest and closest medical provider is always best. 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. 
  • Natural disasters cause accidents.
  • Illness or damage 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 filing the claim, 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 and Workers Comp Cover

It is also important to know that not only are physical injuries covered. But also mental health issues can 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 resulting from the accident?

Some healthcare professionals at mentalhealth.org.uk consider mental & physical health as a unibody, so to speak. The poor physical condition affects an individual’s mental State of mind, causing risks that further impair the brain and the whole body. In the same way, a poor state of mind can be proven detrimental to a well-maintained physical body. Research shows that 32% of people suffering from high levels of distress can most likely die from cancer. Similarly, depression is also identified as one of the contributors to coronary heart disease. Hence, physical and mental health should be treated equally and considered imperative to one another.

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 work-related stress is considered PTSD and can be compensated?

Stress is something that everyone experiences from time to time. However, the stress felt after a traumatic accident may be no longer everyday stress. It could be that the employee is suffering from *PTSD. This is a severe 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 happens.
  • Must be diagnosed by a psychiatrist or psychologist.

Symptoms that last 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 to prevent anxiety from worsening and potentially becoming PTSD.

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

More about PTSD

Although PTSD caused by physical injury in the workplace is the most common mental illness associated with this situation, it is also noteworthy to become accustomed to other mental illnesses that can affect employees at work. Depression and anxiety–also known as panic disorders are two of the most widely observed mental illnesses developed in the workplace. These illnesses shouldn’t be taken lightly because they are as deadly as terminal diseases.

According to a public information sheet published on the World Health Organization’s site, depression and anxiety are usually the reported problems that cause substantial changes to an individual’s State of mind. These illnesses are formed and developed through constant harassment (Physical, sexual, and/or mental), bullying from colleagues and bosses, and even stress from work overload. And from there, an employee can greatly suffer a bunch of diseases linked to the aforementioned mental illnesses but not limited to:

  • Heart Complications
  • Multiple Sclerosis
  • Hypothyroidism
  • Stroke
  • Hormone Imbalance

It is said that depression is one of the leading contributors to the loss of productivity worldwide. As a result, it paralyzes growth in both the micro and macrostate. In 2019, the WHO reported an estimated global economic loss of USD1 Trillion per year in lost productivity. Furthermore, inadequacy and disability due to mental illness pose a huge threat to business owners, working professionals, and society. 

Therefore, everyone is responsible for keeping themselves physically able and mentally sane.

In the event of a positive diagnosis, one should immediately seek medical advice, as many effective psychological and pharmacological treatments are available.

What do workers comp cover? Here are the Coverages available for a valid claim

Short-Term and Long-Term Care for workers comp cover

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.

These injuries may vary from simple cuts and bruises to sports-like sprains and pull & tear. 

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.

Some examples are injuries caused by avulsion wounds, twisting & breaking of bones, and dislocation of joints (among others).

*Both short & long-term care applies to mental illnesses too.

Permanent Disability in Workers Comp Cover

A permanent disability can be physical, mental, or both simultaneously. A person’s injury is considered a permanent disability when the individual is severely limited in his physical and mental activities rendering him immobile in both states. Some of the most common permanent disabilities are as follows:

  • Amputation
  • Cerebral Palsy
  • Spinal Cord Injury (SCI)
  • Severe Epilepsy
  • Muscular Dystrophy
  • Cystic Fibrosis (CF)
  • Spina Bifida
  • Acquired Brain Injury

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 is deemed permanent and the employee can no longer perform the same type of work as before. 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 in Regard to Workers Comp Cover

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

The demand for compensation to cover the damages incurred by the injury that happened on-site and potential earnings they could’ve gained during their absence from work. Moreover, they should be able to prove in front of a court or jury the sum total amount of their claim. The employer can be their aid for the claim since they are solely or partially responsible for their worker’s well-being. 

Normally, lost wages compensation is computed by multiplying your hourly rate by the number of days you’ve missed work and how many hours you render each day. If you’re also likely to work overtime during shifts, you might as well include that in the computation. 

It is more important than ever to ensure that your business is covered if an employee is injured or becomes sick while on the job.

It wouldn’t hurt to be more knowledgeable and engaged during these events. Gather data, jot down every detail, and try to minimize or cause further damage to yourself, your business, the workplace, your employees, or colleagues that can be affected by the situation. Ultimately, we believe everyone’s safety and well-being should be paramount. 

Contact Us Today Regarding Workers Comp Cover

We hope you learned a lot regarding workers comp cover. At Advantage Insurance Solutions here in Denver, CO, we take pride in our ability to work with business owners to customize an insurance plan that will meet the unique needs of your business. Our insurance professionals will search dozens of carriers to ensure your business has the best coverage at rates that fit your budget.

Contact us today and talk about how we can help you minimize the financial risks of running your business.

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