Understanding Work Related Injuries

Have you ever thought what would happen if you got hurt on the job or while traveling between offices or worse yet if you get sick because of the type of work that you are employed to do? If you sometimes think about this there is no need to worry. The reason that I say this because every company out there Federal and State alike are required to have workers compensation benefits. There are rules and regulation that are put into place to keep you safe while on the job or on the company’s property.
The organization that oversees this would be the Occupational Safety and Health Administration (OSHA) that was developed in 1970 to protect workers from health and safety risks. Although all employers are overseen by OSHA there are a select few that are not these would be independent contractors, churches, domestic workers in private home settings, and federal employees (Valerius?Bayes?Newby?Seggern, 2008). Federal employers have their own compensation plans that are covered under the Federal Employees’ Compensation ACT (FECA).
The first of four plans would be the long shore and Harbor workers’ compensation plans. This covers employees of in the maritime field. The second federal program would be the Black Lung Program. This covers employees that are employed or previously employed in coal mines. The third and final program is the energy employees occupational illness compensation program act. This covers employees or previous employees that have developed cancer and other serious illness from energy exposure.

State worker’s compensation covers all others except federal employees, inmates employed by the prison; self- employed, for hire domestic, drivers under lease agreement, volunteers, independent, clergy and church members, and lastly agricultural laborers. No matter if you are a state or federal employee there are two different workers compensation programs that you will be covered under. The first one covers the medical costs that are incurred due to the injury; the second covers the lost wages that has come from the injury.
When a person is injured on the job, on the company’s property, or performing a work related task they will be covered under workers compensation. If an employee is injured they need to inform their employer promptly so that proper medical treatment can commence. The employee usually needs to put the injury in writing also known as the first report of injury, the physician depending on the insurance may need to be the one to fill this form in.
Once this is done the employer also has to file their own claim with the state workers compensation office as well as the insurance company (Workers Compensation- the Workers’ Comp Service Center, 2009). Depending on the severity and urgency of the injury the insurance company may require a form to be filled out by the physician of record. The physician of record is the physician who first treats the employee. This physician is also responsible for determining the amount of disability and if and when the employee may return to work.
The Physicians of Record must according to insurance company or state regulation must file a progress report at certain intervals of the treatment or when there is a change that will affect the disability status. Once the insurance company gets the claims that may be filed electronically depending on the carrier has to now issue a claim number and identify if the injury will or will not be covered by workers compensation.
Once this is determined than the insurance company needs to notify the employer on the determination. If the claim is accepted than monies that the employee loses from not being able to work are sent right the employee with no income tax being withheld and all medical bills are paid. If the claim is denied by workers compensation than the employee is responsible for the medical bills and may submit the medical bills to their own medical insurance carrier to be paid, but the employee does not receive lost wages.
No matter what the outcome is of the claim HIPPA rules and regulations are not strictly enforced to keep the privacy of the injured employee. However, most states allow claims adjusters and employers unrestricted access to the workers compensation files. Patient Health Information may be disclosed without the patient’s authorization. The employee cannot even ask that their information be withheld from the employer.
Valerius?Bayes?Newby?Seggern. (2008). Medical Insurance: An. The McGraw?Hill. WokersCompensation- The Workers’ Comp Service Center. (2009). Retrieved May 15, 2011, from WorkersCompensation.com: http://www.workerscompensation.com/
Valerius, Bayes, Newby, Seggern. (2008). Medical Insurance. In An Intergrates Claims Processing Approach, Third Edition (pp. 292 – 298). New york: McGraw Hill. WokersCompensation- The Workers’ Comp Service Center. (2009). Retrieved May 15, 2011, from WorkersCompensation.com: http://www.workerscompensation.com/

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