When a patient is dealing with a workers comp injury, they often feel unsure of the process and concerned about their coverage. While this may seem intimidating, there are options for every patient and ways to go about handling it. Every patient matters, and people who experience workers’ comp injuries are sometimes overlooked. Learning how to handle your worker’s comp injury is extremely important so that you can move forward with your life!
What is Workers’ Compensation?
Workers’ comp is a shortened phrase for “workers’ compensation.” It is a form of health claim which goes through a person’s place of employment instead of through their own personal health insurance. In most states, all workplaces with at least one worker must have a workers’ compensation policy. This policy varies but generally says that if a person is injured in the workplace, their related healthcare will be covered by workers’ compensation insurance. Most of the time, there are no copays for the individual. Workers’ comp claims are often small and short-term, but some claims can take years to complete and would be very expensive for the worker without this coverage.
Claim Denial
Sometimes a workers’ compensation claim can be denied or investigated. Sometimes people are injured in the workplace but already have symptoms or other things that cause the injury. If this happens, their claim can be denied and the individual will have to use their own insurance or pay for the injury out of pocket. This does not often happen, but it is a possibility.
What Does Workers’ Comp Cover?
Workers’ comp doesn’t just cover the injury of the person. The main goal of workers’ comp is to give the employee the same life they would have without the injury. This means that workers’ comp will cover lost wages, ongoing care costs, medical expenses, and even funeral expenses if a person passes away due to a work-related injury. It also can cover part of or all of disability payments due to a workplace injury. This is intended to help the employee have an adequate quality of life, and have the ability to go back to work when they have recovered.
What Isn’t Covered by Workers’ Comp?
You should be able to tell if you are eligible for a workers’ comp claim. However, you may make a workers’ comp claim without knowing that it will not be covered. Let’s make sure that doesn’t happen.
There are a few things that a workers’ comp claim will never cover. If the injury is caused on purpose or if determined that a worker caused an injury to themselves to get workers’ comp, their claim will be denied. Additionally, if a worker starts a fight in the workplace and is injured, any injuries from the fight will not be covered either.
Other possibilities that may lead to a claim being denied would be if the employee is under the influence or not wearing proper safety gear. Employees that are not sober, and are injured as a result, often find their claim is denied. In the same vein, employees who were not wearing the required equipment, and are injured as a result, will be denied as well. Workers’ comp is designed to cover people who are injured accidentally as a result of everyday workplace dangers or accidents.
How Does Workers’ Comp Work?
There are several steps in the workers’ comp process, which start with a healthy individual working. Understanding the process of how workers’ comp works is important for every working person.
Injury Occurs
First, when an injury occurs (like a broken bone, cut, or fall), depending on the severity of the injury, the employee and manager must fill out an incident report of what occurred. If the injury is serious enough to warrant immediate care, the incident report can wait until the injured individual receives emergency treatment. No matter what occurred or how serious it is, the employee should immediately report the injury. The injury report needs to be filled out with as many important details as possible. When did the injury occur? What exactly happened? Was anyone else injured? Who witnessed the injury? These are all important to record.
Medical Treatment
The employee should receive medical treatment as soon as possible. Each state has different requirements for doctors involved in workers’ compensation claims. However, most of the time they require the doctor to notate specific things and take notes regarding the patient’s state and the injury. In some states, there are certain in-network hospitals or clinics that can accept their plan, just like with personal medical insurance.
Employer Report
Once the employee has received care, the employer must report the incident to their workers’ comp carrier. Some companies require an injury to be reported in a certain time frame. They will report all relevant information about the employee and the incident.
Carrier Contacts Injured Employee
The workers’ compensation company will then contact the employee and ensure that they understand their coverage. The employee will need to sign some paperwork that releases medical information and fill out other relevant forms. They will also decide if they will accept or deny the claim.
Make a Plan
At this stage, the employee, doctors, and workers’ comp company will work together to create a “return to work” plan. This will streamline care and help the employee prepare to return to work. This can take a few days, weeks, months, or even years to complete depending on the injury. Most of the time these are simple and take a short time to complete.
Return to Work
Hopefully, all will go well and the employee will return to work shortly, with the same or similar conditions as before the incident occurred.
Workers’ Comp at Foot & Ankle Specialists of Illinois
At our office, we do our best to ensure that every patient is well cared for. Are you trying to make a plan to get back to work? We will work with you to help you get better as quickly as possible. We will use the latest technology and medical processes to take care of you, and get you back on your feet in no time!
