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Feb 23, 201509:13 AMOpen Mic

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Answers to frequently asked questions on workers’ compensation

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In nearly all states, employers with one or more employees must provide workers’ compensation. When an employee gets injured at work, a number of questions may arise, including whether the injury is covered by workers’ compensation, whether the injury must be reported to the insurer, whether the employee can use vacation during injury leave, and whether a denial of workers’ comp coverage affects the recording obligation on the Occupational Safety and Health Administration (OSHA) 300 Log. These questions are addressed in this article.

Q: How is coverage determined?

A: An injury will generally be covered if it arose in the course and scope of employment. This determination is not always simple, so it should be made by the insurance carrier or other managing agency. Even an initial denial of coverage could be challenged by the injured employee.

For example, in one case, an employee was leaving for home at the end of the day. As she was pulling her car out of the company parking lot, her vehicle was struck by another vehicle on a public road and she was injured. An injury that occurs during a commute is not normally covered, so her claim was initially denied, but she appealed. A security camera had recorded the accident and showed that approximately one foot of her vehicle was still in the company parking lot at the moment of impact. For that reason, a judge determined that her injuries were covered by workers’ compensation.

Q: Must every injury be reported?

A: If the injury is covered (or likely to be covered) by workers’ comp, it should be reported to the insurer. Most states provide a form to report injuries, which can usually also serve as the OSHA 301 Incident Report. State laws establish time frames for filing the initial injury reports, typically from seven to 30 days after the employer learns of the injury.

Since workers’ comp is an insurance program, the number of claims and total cost of claims will affect the premiums. To control costs, some employers do not report minor injuries, choosing to pay for treatment out of pocket. Employers should verify that their state law allows this and should keep in mind that a seemingly minor injury could later require medical treatment because of infection or other complications. If the deadline for filing the injury report has passed by that time, the employer would have to continue paying out of pocket for any medical expenses, no matter what the total cost, because the injury could have been covered if not for the failure to report it.

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