Employees who are injured at work may be eligible for benefits under the Virginia Workers’ Compensation Act. Workers' compensation insurance and benefits exist to help employees who are injured while doing their job.
Workers compensation insurance is required by state law in Virginia (the Virginia Workers’ Compensation Act) for most employers, including small businesses; established to provide specific benefits to workers injured in and out of the course of their work and to provide businesses with some protection from civil lawsuits for work related injuries. As a general rule in Virginia, a business with more than two employees is required to carry workers’ compensation insurance. What constitutes an employee is broad, and includes part-time, seasonal and temporary workers, minors, trainees and others.
An injury at work is what kicks off the start of the workers’ compensation process, initiated by an employee reporting and incident and the business working with them to make a workers’ compensation claim. When an employee is injured on the job or in a workplace accident, there are four types of workers compensation benefits that an employee could be owed: medical coverage, wage benefits, vocational rehabilitation, and death benefits.
Medical Coverage
Medical coverage under workers’ compensation includes the costs of necessary treatments related to your workplace disability or injury. The claims are generally not limited to a specific dollar amount, with workers’ compensation typically covering the deductibles and copays an employee would normally face.
Additionally, medical coverage may include compensation for hospitalizations, nursing care, medical equipment like wheelchairs or walkers, medications and other necessary treatments or therapies.
Wage Benefits
Workers' comp benefits can also cover a percentage of an employee's wages, commonly known as disability benefits. Usually, an employee receives these benefits if an injury leaves the employee unable to work permanently or temporarily. The length of time the benefit is received and the monetary amount of the benefit are determined by the severity of the injuries, how long they will prevent an employee from returning to work and any applicable laws.
Vocational Rehabilitation
This benefit is to help employees who have become disabled or injured due to a work injury return to work. If an employee is unable to return to a previous position or job, vocational rehabilitation can be included as part of a workers’ compensation claim. The National Rehabilitation Information Center (NARIC) states that vocational rehabilitation may include job training, career counseling and assisting in finding a new job.
Death Benefits
The family members of an employee who dies from injuries sustained in the workplace may get death benefits from workers’ compensation. The benefits are paid to the employee's spouse, children or dependents. Typically, the benefit is a sum that compensates the family for the loss and covers the costs of funeral and burial expenses.
How Businesses Should Handle Workers’ Compensation and Claim Administration
The starting point for employers and workers’ compensation is to make sure you are in compliance with all laws and the parameters for any required coverage. This will set a good foundation for any claims that may come up down the road. You should assess your individual business and industry in determining how ready you need to be to deal with an employee injury; while every business should take some steps to prepare for an employee to be injured, certain industries and businesses will have a higher rate of employee incidents than others simply due to the nature of the work or job being performed.
Companies should educate employees on workers’ compensation coverage, and reporting requirements in the event of an injury or illness. Create policies and procedures that are readily available and in the employee handbook that walk employees through the steps to the workers’ compensation process.
If an injury or illness occurs on the job there is a limited amount of time in which the injury needs to be reported and a claim filed. Failure to do so could result in the denial of benefits. This is why the policies, procedures and training is an important part of businesses protecting themselves. It’s typical for the employer to be responsible for submitting a claim to the insurer, but the incident needs to be properly reported and documented first.
You should make sure that your employees know they need to report an injury or illness as soon as possible, ideally in a written notice. The employee should document the injury or illness, the date of the injury or illness and the circumstances that lead to the injury or illness. The time frame of an employee notifying the employer will vary based on state law.
Once you’ve been notified, you should provide the employee with information on their rights and the workers’ compensation benefits. While this information should be available in the handbook and new hire information, it’s smart, and good risk management practice, to provide all the necessary information and paperwork to the employee again upon the reporting of an injury or illness. Failure to provide this may lead to a lawsuit you could have avoided.
It’s usually the responsibility of the business to send the claim and all supporting documentation to the workers’ compensation insurance carrier, but you’ll likely need some information from the doctor as well to submit a medical report. Don’t overlook a potential requirement to submit or report to your state's division of workers’ compensation or workers’ compensation board. Some states may require a reporting of all workplace injuries even if an employee isn’t going to seek workers’ compensation.
Once you provide all the necessary information to have the claim processed and reviewed, the insurer will either approve or deny the claim. If the claim is approved, the insurer will usually inform the employee and coordinate payment details. If the claim is denied the employee will probably have the option to request a reconsideration from the insurance company or file a formal appeal.
Once an employee has recovered from an injury they are able to return to work; they should provide you and the insurance company with written notice of this. As discussed above they may return to full duties, some modified duties or they may end up on permanent disability.
There is often some confusion about how OSHA and workers’ compensation are related. Simply put, they are not. OSHAfocuses on workplace safety, while workers’ compensation deals with injured employees who may need care or a benefit due to a workplace injury.
Have questions about workers’ compensation or how to proactively manage risk in your business? Contact us for a free consultation.