What Four-Letter Word Do You Use When You Have to Write A Check for Your Workers Comp Coverage? Find Out Revolutionary, Hidden Myths About This Despised Coverage We All Must Pay For  Right Here, Right Now!

Do you need workers compensation insurance?

Employers have a legal responsibility to their employees to make the workplace safe. However, accidents happen even when every reasonable safety measure has been taken.

To protect employers from lawsuits resulting from workplace accidents and to provide medical care and compensation for lost income to employees hurt in workplace accidents, in almost every state, businesses are required to buy workers compensation insurance. Workers compensation insurance covers workers injured on the job, whether they're hurt on the workplace premises or elsewhere, or in auto accidents while on business. It also covers work-related illnesses.

Workers compensation provides payments to injured workers, without regard to who was at fault in the accident, for time lost from work and for medical and rehabilitation services. It also provides death benefits to surviving spouses and dependents.

Each state has different laws governing the amount and duration of lost income benefits, the provision of medical and rehabilitation services and how the system is administered. For example, in most states there are regulations that cover whether the worker or employer can choose the doctor who treats the injuries and how disputes about benefits are resolved.

Workers compensation insurance must be bought as a separate policy. Although some business insurance is sold as “package policies”, they don't include coverage for workers' injuries.

Policy Exclusions

Let’s get one thing clear… All policies have exclusions. You hear terms like all risk, special form, comprehensive, full coverage. Those phrases do not mean there are no exclusions. Companies use exclusions because certain exposures to loss may be too great to cover under a standard policy, or simply too great for the company to consider insuring. If you would like to have a particular exclusion removed, ask us and we will see whether your insurance company or another specialty insurer we work with can provide the coverage.

Here’s some Free Answers to Your Questions:

Who's Covered?

Virtually all working Californians are "employees" for purposes of workers' compensation. Exemptions are few. People in business for themselves and some unpaid volunteers may not be covered. Similar federal laws protect maritime workers and federal employees.

What's Covered?

Any injury or illness is covered if it's caused by the job. The key question is whether the condition "arose out of and occurred in the course of employment".

When does coverage begin?

Employees are covered from the first moment on the job. There's no waiting period, no requirement to work so many days or weeks, no need to earn a minimum amount.

What benefits do injured workers receive?

• All reasonable medical care. Not just doctors bills, but also medicines, hospital charges, lab tests, X-rays, crutches. There's no deductible, no limit in time or amount.

• Employees with serious injuries that prevent them from returning to their usual job may qualify for vocational rehabilitation.

• Partial replacement of lost wages. The most common payment is for "temporary disability" - two-thirds of the employee's average weekly wage up to a maximum set by the state legislature.

• If the injury results in a permanent impairment (amputation of a finger for example), additional "permanent disability" payments will be made after the employee reaches maximum recovery.

• In fatal injuries, surviving dependents will be paid death benefits.

How do I report a claim?

When an injury happens, give the employee a claim form. State law requires the employer to furnish the claim form within one day after knowledge of the injury. After the employee completes it, give the employee a copy and send another copy to the insurer. Most importantly -- even if the employee hasn't returned the claim form -- complete the Employer's Report of Injury and send it to your insurer

Click on the Adobe Acrobat Icon to download the free software that will allow you to view and print the form below. If you already have Adobe Acrobat, simply click on the link below to view and print the file.

Click here to download Employee Claim Form for printing

Click here to download Employer's First Report Form for printing

State law requires the employer to file the Employer's First Report within five days of the injury. In the event of an employee's death-- even a case that doesn't appear to be work related -- notify the insurer immediately by telephone or fax.

Urgent Information about Medical Care

Quality medical care is imperative to all parties concerned in a workplace accident. It is also critically important that a physician who has the best interest of all parties in mind administers medical care.

Here’s a few tips to help get the right care: 

• If first aid is available at your workplace, get immediate treatment and report where, when and how the accident happened immediately to a supervisor. If it is an emergency, get the best treatment available, then report the injury to the insurance company as soon as possible.

• To make certain the employee gets the proper benefits, complete the above claim form and call or fax to the insurance carrier immediately. Most companies offer 24/7 claim hotlines.

• If additional medical care is necessary, and the employee hasn’t selected a physician or health care organization prior to the injury, your insurance carrier claims department can recommend a treatment facility. The doctor they recommend will be familiar with workers’ compensation requirements and will report promptly so benefits can be paid.

• If the employee wants to change doctors for any reason, ask the insurance carrier claims representative before authorizing any changes in medical care. The company is very interested employee’s prompt recovery and return to work and will give you a list of other qualified doctors to choose from.

• The employee is entitled to be treated by their own personal physician if they have notified the employer of the doctor’s name and address in writing before the injury.  For further information, ask our office for details.

•  If the employee hasn’t predesignated a physician before the injury, they can switch to their own doctor after the employer’s medical control expires. This is usually 30 days after the injury is reported. There are special rules governing employer medical control that apply if you are a member of a Health Care Organization (HCO). Check with your claim adjuster if that’s the case. If the employee switches care providers, have them choose their doctor carefully - most people don’t have a family surgeon, for example.  If the employee wants advice about specialists, then talk to the claim adjuster or our office first. Regardless, report the employee’s choice as soon as they make it so the bills will be paid for them.  Above all, don’t have the employee treat him or herself.  Even minor injuries need expert care.  Prompt, quality medical care from a quality, caring provider is the best investment the employee and employer can make.

Remember - Safety and Prevention equals lower premiums. It’s as simple as that.

What is covered and what is not covered by an insurance contract is challenged every day in court. Needless to say the scope of what your insurance contract will cover also changes. The description above is intended for informational purposes only. If you have any legal questions, please contract a lawyer.

Read your policy it is a legally binding contract between you and your insurance carrier.

PS - Be a smart consumer...but don't try to be your "own agent." Protection for you and your business requires constantly vigilance....and a partnership between you and your professional agent. For the latest information on how to save money AND get the best protection for yourself and the people you care most about, here's 3 easy ways to reach us:

Toll-free Phone - 877-994-6787

Toll-free Fax - 888-467-7968

Email - chef@zipdrip.com 

This information has been gathered in part from the California Workers Compensation Institute

 © 2004 Stromsoe Insurance Agency, Inc. The reader assumes all responsibilities for his/her own actions in regards to any items discussed in this report. Adherence to all applicable laws and regulations, federal, state and local, governing the use of any product or service described in this report in the US or any other jurisdiction is the sole responsibility of the reader. The publisher and author assume no responsibility or liability whatsoever on the behalf of the reader of these materials. The reader is encouraged to consult directly with his/her insurance

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