Understanding workers compensation insurance and your employees care options.

If you’re new in the business or just switched to a new workers’ compensation provider, it can be challenging to understand exactly what your policy covers and how to convey this information to employees.

With new workers’ compensation policies, both employers and employees often have questions about what injuries and illnesses are covered by the policy and where an employee can seek treatment. You may be wondering, how does workers comp work on the health care side of the equation?

Workers’ Comp Coverage Basics

If your employee gets hurt in the workplace or while offsite performing their work responsibilities, workers’ comp insurance will provide compensation. The policy also covers occupational illnesses and injuries aggravated by working conditions.

The benefits extended to employees varies according to the laws of each state, but a workers’ compensation policy usually helps to cover:

  • Medical Expenses– All procedures necessary to treat the worker, such as medical appointments, hospital treatments, health care nursing, medication, physiotherapy, and any equipment needed for long-term or permanent use, such as wheelchairs.
  • Ongoing Care– Some work-related injuries or illnesses require long-term care or rehabilitation support, such as physical therapy. Workers’ comp can also help cover these forms of ongoing care.
  • Lost Wages– The policy can cover loss of wages if the injured or ill employee needs to take leave from work while recovering.
  • Vocational Rehabilitation– If the employee needs ongoing care to help them get back to work, vocational rehabilitation allows them to learn a new skill. Some states also offer psychological rehabilitation services associated with their recovery.
  • Death Benefits– In the case of a workplace fatality, death benefits are paid to the partner, minor children, and other dependents. The policy typically covers burial costs.

Medical Provider Options for Employees

Each state has different laws about which health care professional services workers’ comp policies must cover. A few different state policies include:

  • In some states, employees can only receive covered treatment from professionals selected by the insurance provider.
  • In other states, employees can receive compensation for the care provided by their own chosen doctors.
  • In other states, employees must see a doctor selected by the insurance provider and then switch to their own doctor after that first visit with the provider’s chosen physician.

Each state also has different policies for continued care, the duration of care, and other details. Some allow the employee to be treated by other specialists, such as chiropractors and naturopaths, but at the same time can limit the number of visits covered by the workers’ comp.

To better understand your policy and advise employees about their benefits, see the workers’ comp medical provider laws in your state, and be sure to talk to your insurance agent about your employees’ options.

Working With a Nurse Case Manager

Nurse case managers are registered nurses often hired by insurance companies to monitor individual patients’ treatment or care. They can assist employees covered by a workers’ compensation policy in the following ways:

  • They ensure the injured or ill worker gets the medical care they need.
  • Nurse case managers serve as liaisons between all parties involved in the claim, including the injured employee, their doctors, their employer, and the insurer.
  • They provide an insurance appraiser with all necessary information about treatment authorizations and medical appointments.

Processing Prescriptions

Each state has its own laws regarding how medications are prescribed to entitled employees and how they’re paid. In some states, the employee can choose any pharmacy; in others, the insurer can determine which pharmacies employees must use. Some insurance companies also have their own pharmacy benefits program.

As an employer, you should understand your state’s laws and discuss the options available to your employees with your insurance agent.

Workers’ Comp and Employer Responsibility

As well as you may maintain a safe work environment, accidents can happen. According to the US Bureau of Labor Statistics, private industry employers reported 2.8 million non-fatal workplace injuries and illnesses in 2019 alone.

Of course, the ultimate goal is to deter injuries by eliminating hazards and educating employees about workplace safety. But aside from that, it’s critical for business owners to understand your state’s workers’ compensation laws and your policy details—it’s your responsibility to inform employees of their entitled benefits.

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