A reader asks: Is there a guide for employers’ rights? Who makes the final decision to award a disability retirement? Who checks to insure that there is no fraud being committed?
The short answer to these questions is “prevailing state law.” All jurisdictions have variations in the laws that govern the rights and responsibilities of both the employer and employee. Each state insurance authority also has a mechanism for reporting suspected fraud. While your workers comp insurer might investigate a claim and accept or deny it based on the circumstances of the claim, their interpretations are subject to review by state workers comp boards and authorities if challenged by the employee. You can find a link to your state workers comp authority on the All 50 States’ and D.C.’s Home Pages and Workers’ Compensation Agencies site. Or the Department of Labor offers a an overview of State Workers Comp Laws that allows you to compare provisions and benefits state by state.
There is a longer answer to this question too, perhaps too long for us to address fully in one fell swoop, but we’ll try. Behind these questions, we pick up a familiar air of frustration. Many employers – particularly small employers – are pretty much in the dark about workers comp until something wakes them up and makes them take notice. That “something” is usually an adverse event: premium rates that suddenly skyrocket, being thrown into the state’s assigned risk (or “insurer of last resort”) pool, or an award of benefits to an employee in a situation the employer perceives as fraudulent or unfair. Many employers we’ve talked to feel mugged by workers comp – they feel like unwitting victims of a system run amuck.
To those employers, we would have a few words of advice: take charge. If you rely on your insurer or some outside party to manage your workers comp experience, you are likely to be frustrated on more than one occasion. Think of your insurer as essentially a financier who finances the risk. A good insurer might provide services to help you prevent, mitigate, or control losses, but essentially their raison d’etre is about money, not the people issues.
Taking control of your experience
At its very essence, workers compensation is not really an insurance problem or a money issue … it’s a people issue, a “human” issue. It’s about your employees and your relationship to your employees. It’s about people who get hurt on the job and how you take care of them. When it comes to your work force and your relations with your work force, the real person in the driver’s seat is you.
There may not be a lot you can do about a past judgment, even if it seems unfair. But the worst thing you could do going forward would be to communicate your frustration to your work force in the form mistrust, suspicion, or unfair practices designed to prevent a repeat occurrence. A punitive approach will tarnish your good relations with your workers and will be unfair to the many good employees that comprise the overwhelming majority of your work force.
The best thing you could do going forward would be to educate yourself about your rights & responsibilities about the law in advance, and to develop a proactive rather than a reactive workers comp program to protect both your business and your employees. Some important components in that program include:
Prevention. We can’t say this enough: the cheapest injuries – both in human and financial costs – are the ones that never occur.
Good communication. Take the mystery out of workers comp. Educate employees about their rights and responsibilities in advance.
A pre-established plan. Train your managers and supervisors in what to do if an injury occurs.
Excellent medical care. Develop a relationship with a superior and responsive physician who understands workers comp and how to treat occupational injuries.
Early reporting. Set an expectation that all injuries be reported promptly; also, have a “same-day” reporting standard for communicating any claims to your insurer.
Good, ongoing communication. Stay in frequent communication with the injured employee throughout the recovery process.
Return to work program. Build a plan to help the injured employee to return to work as soon as possible, including modified duty.
Fairness and consistency. Think of the “Golden Rule” – how would you want to be treated if you had an on-the-job injury? Be consistent and apply the same principles to all.
