Workers_Comp

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					Workers’ Compensation
      Federal and state laws require employers to maintain workers’ compensation coverage to meet
       minimum standards, covering a majority of employees for work-related illnesses and injuries.
        As long as employee was not negligent in the performance of assigned duties

Federal Workers’ Compensation Programs
    U.S. Department of Labor’s Office of Workers’ Compensation Programs administers programs
      that make available
       Wage replacement benefits
       Medical treatment
       Vocational rehabilitation
       Other benefits
    Energy Employees Occupational Illness Compensation Program
    Federal Black Lung Program
    Federal Employees’ Compensation Act Program
    Longshore and Harbor Workers’ Compensation Program
    Department of Labor also manages the following programs designed to prevent work-related
      injuries and illnesses:
       Mine Safety and Health Administration
       Occupational Safety and Health Administration

Occupational Safety and Health Administration
    Protects employees against injuries from occupational hazards in the workplace
    Establishes protective standards, enforces those standards
    Reaches out to employers and employees by providing technical assistance and consultation
      programs

State Workers’ Compensation Program
     Weekly cash payments and reimburses health care costs
        For covered employees who develop a work-related illness or sustain an injury on the job
     State Insurance fund
        Provides workers’ compensation insurance coverage to private and public employers
        Acts as an agent in state workers’ compensation cases involving state employees
     Self-insurance plans
        Employers with sufficient capital to qualify can self-insure.
        They are required to set aside a state-mandated percentage of capital funds to cover
          medical expenses, wage compensation, and other benefits payable to employees who
          develop on-the-job illnesses and/or incur injuries.
     Commercial workers’ compensation insurance
        Employers are permitted to purchase policies from commercial insurance companies.
     Combination programs
        Employers in some states are allowed to choose a combination of any of the above to
          comply with workers’ compensation coverage.

Eligibility for Workers’ Compensation
     Employee is either
         Injured while working within the scope of the job description
         Injured while performing a service required by the employer
         Succumbs to a disorder that can be directly linked to employment, such as asbestosis or
           mercury poisoning
       Worker does not have to be physically on company property to qualify for workers’
        compensation.

Temporary Disability
    Covers health care treatment for illness and injuries as well as payment for lost wages
      Temporary total disability
      Temporary partial disability

Permanent Disability
    Diminished capacity to return to work
    Subclassifications:
      Permanent total disability
      Permanent partial disability
      Schedule loss of use
      Disfigurement

First Report of Injury
     Patient comes in for work-related injury.
        Report of injury forms should be completed.
        Copy should be given to each of the following:
           State Workers’ Compensation Board/Commission
           Employer-designated compensation payer
           Ill or injured party’s employer
           Patient’s work-related injury chart
     Time limit for filing this form varies from 24 hours to 14 calendar days, depending on state
       requirements.
     Patient’s employer must be contacted to obtain the name and mailing address of the
       compensation payer.

Necessary Information
    Name and address of present employer
    Name of immediate supervisor
    Date and time of accident or onset of disease
    Site where injury occurred
    Patient’s description of onset of disorder

What Should be Documented
   Patient’s name and compensation file/case number
   Treatment and progress report
   Work status at the present time
   Statement of further treatment needed
   Estimate of the future status with regard to work or permanent loss or disability
   Copies of substantiating X-ray, laboratory, or consultation reports
   Physician should sign original and photocopies of reports
Progress Reports
    Should be filed to show any changes in a worker’s medical or disability status
    Should be generated in duplicate:
       One copy is sent to the compensation payer.
       One copy is retained in the patient’s file.

Fraud and Abuse
    Fraud occurs when individuals knowingly obtain benefits for which they are not eligible.
    Abuse occurs when the workers’ compensation system is used in a way contrary to its intended
       purpose or to the law.

Employer fraud
   Employer misrepresents payroll amounts or employee classification.
   Attempts to avoid higher insurance risk by transferring employees to a new business entity that
      is rated in a lower-risk category
   Lies or provides false statements
   Intentionally fails to report income from work
   Willfully misrepresents a physical condition to obtain benefits from the state compensation fund

Provider fraud
    Inflate bills for services for nonwork-related illnesses.
    Bill for treatment of nonwork-related illnesses and/or injuries.

				
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