Employees who suffer from workplace accidents or illnesses have the right to receive benefits covering their medical expenses and time off. Companies must provide this insurance as a part of their employee benefits. Navigating the workers’ compensation system can become confusing, even for those who clearly understand the law. Requirements vary by state, and compliance is a must. This guide will help HR managers navigate the workers’ compensation system to protect injured employees and the company.
What Is Workers’ Compensation?
Workers’ compensation is an insurance program mandated at the state level. This coverage benefits employees who become injured or ill due to their employment. Because injured employees receive these benefits, they give up their right to sue their employer. Workers’ compensation programs help protect injured workers and their employers.
Some companies hire workers compensation attorneys to help them understand their state laws and ensure compliance. HR managers must educate themselves on their state laws and those that pertain to their specific industries. Some industries are high-risk, such as manufacturing and construction, and may have further workers’ compensation requirements.
What Role Does HR Play in Workers’ Compensation?
HR managers play a significant role in overseeing the workers’ compensation process. Managers perform the following:
- Reporting employee injuries promptly
- Communicating with the insurance carriers
- Coordinating the injured employee’s return to work
- Educating employees about their rights and responsibilities
When HR managers handle workers’ compensation claims efficiently and effectively, employees feel protected, and companies experience fewer incidences of litigation.
Reporting the Employee Injury
Each state has laws regarding reporting time, which typically ranges between 24 hours and 30 days. Employees must notify the HR department as soon as possible to prevent delays in efficient processing.
It is the HR manager’s responsibility to fill out the First Report of Injury Form. This form provides details to the insurance company about the accident, the nature of the injury or illness, and any medical treatment received. If the HR department does not provide the FROI form, they may face penalties and could cause delays or denials. Delays hurt both injured employees and their companies.
Investigating Workplace Accidents
Once the HR department receives an injury report, they must investigate. The investigation assists the department in determining the claim’s validity and ensuring workplace safety to prevent further accidents. HR managers are responsible for the following investigative steps:
- The HR manager will interview the injured employee to learn about their injuries and the accident that caused them.
- HR managers will also obtain and review any security footage regarding the accident.
- The manager will inspect the accident site to determine the cause of the accident.
- HR managers will document their findings to ensure factual reporting to the insurance company.
A thorough investigation is required for all workplace accidents resulting in injuries or illnesses. The inquiry aims to determine if the injuries were caused by an accident in the workplace. HR managers must investigate carefully to help avoid fraudulent claims.
Filing the Workers’ Compensation Claim
The HR manager is responsible for filing the workers’ compensation claim after performing an investigation. The manager must ensure all forms are filled out correctly, and all necessary documents are provided to the insurance company. After making the report, the HR manager should continue contacting the injured employee and ensuring they are informed of any developments. It is up to the insurance company to approve or deny the claim.
Medical Treatment Management
Upon approval, the employee can receive paid-for medical care until they recover or long-term care if their condition is permanent. HR managers must become coordinators between medical providers and insurance companies, ensuring the injured employee’s medical bills are covered. They must also keep highly detailed records of all medical reports, progress reports, and treatment plans.
Some states have a list of approved medical providers that injured employees can see, while others allow people to choose their providers. HR managers must educate themselves on state laws to help employees make the right decisions for their care. Proper documentation becomes essential in the case of disputes and in helping the employee return to work.
Overseeing Return-to-Work Programs
Return-to-work programs help injured employees return to work as soon as possible. The HR manager oversees these programs and ensures injured employees can access support services. HR managers will work with the employee and their medical team to make accommodations and open a clear line of communication to ensure the employee transitions back to work with as little stress as possible.
Dispute Management
Some workers’ compensation claims do not go smoothly, causing disputes. Common subjects of disputes revolve around denials, benefit amounts, and medical care. HR managers work with the company’s legal team to handle disputes appropriately. The HR department’s thorough documentation can help with disputes.
Fraud Prevention
Fraud prevention is a significant responsibility of HR managers. Some employees will either fake or exaggerate injuries. Fraudulent claims become costly to both employees and their employers. HR managers will look for red flags like a lack of witnesses, delays in reporting, inconsistent accounts, and a history of previous claims. A lack of medical documentation can also prove fraud, but not always.
Adherence to State Laws
Another critical role of HR managers is adherence to laws. Non-compliance with state laws can result in fines, penalties, and investigations from state regulators. HR managers should undergo ongoing training in workers’ compensation to stay abreast of changing laws impacting how they handle workers’ compensation claims.
HR Managers Must Learn to Navigate the Challenges of Workers’ Compensation
HR managers play an integral role in processing and managing workers’ compensation claims. They investigate accidents, file claims, coordinate care, and ensure employees receive the support they need to return to their jobs. HR managers must stay informed of changing laws and ensure compliance. A well-managed workers’ compensation program is good for employees and companies. Employees feel safer and more valued, and employers do not have to worry about litigation that could bring their businesses down. With HR managers at the helm, workers’ compensation claims are less taxing to everyone involved.
