In this session, we’re going to look at workers’ compensation, because workers’ compensation insurance is an important part of our overall safety and health system.

You need to understand how our workers’ compensation program works so that you can help injured employees get prompt and proper care and so that you can ease the transition back to work when they are recovered.

You also play an important role in helping the organization keep down workers’ comp costs and prevent workplace injuries and illness.

Session Objectives

The objective of this training session is to explain our workers’ compensation program. At the end of the training session, you will be able to:

• Recognize the purpose and benefits of workers’ compensation;
• Complete reports and help workers file claims;
• Maintain contact with employees on leave and ease their return to work; and
• Help prevent workplace accidents and keep workers’ comp costs down.

Session Outline

In this session, we will look at:

• Workers’ comp, what it covers, and when it applies;
• Costs and special provisions;
• Claims and reporting requirements;
• Contact during leave and the return to work;
• Dealing with permanent disabilities; and
• Preventing workplace accidents.

Benefits of Workers’ Comp

This session is important because we want all employees who are injured or become ill on the job to get the care they need and be able to support their families while they are out of work. And we want them to have a successful transition back to work. At the same time, we want to try to keep our costs down. Our workers’ compensation program helps us achieve both those important goals. Moreover:

• Workers’ comp is good for our company and our employees.
• It ensures prompt and proper care for work-related injuries and illness.
• And, it provides income while workers recover and eases their return to work.

What Is Workers’ Comp

Let’s begin with a little background. Before 1911, workers who were injured on the job or became ill because of their work were out of luck—as well as out of work. They had to bear the cost of all medical expenses by themselves. And if they were unable to return to work, they had to rely largely on the charity of their family, friends, neighbors, or church to survive. Workers’ compensation laws changed all that. Here’s how:

• Workers’ compensation is an accident insurance program covering employees’ work-related injuries and illness.
• Workers’ comp is regulated at the state level. Each state sets the rules for coverage, costs, and benefits. This means that the rules vary somewhat from state to state.
• Workers’ compensation is compulsory in every state except Texas.
• Finally, companies must pay the full costs of workers’ compensation insurance.

What Does It Cover?

Workers’ comp covers a range of expenses related to work injuries and illness, including the following:

• It covers medical and rehabilitation expenses for employees who are injured or become ill on the job.
• It also replaces a portion of wages while the employee can’t work or if the employee is permanently disabled. A state formula determines compensation for partial or total disability.
• And, workers’ comp also pays death benefits, including funeral costs and wage replacement, to the worker’s surviving spouse and minor children.

Make sure you know your state’s formula for determining compensation for workers out on leave.

When Does It Apply?

When does workers’ comp apply?

• It applies to any injury that occurs while an employee is working, during breaks or lunch, or during work-related or required activities—for example, calling on a client, attending a training session, or going to a conference or seminar. It generally does not apply to injuries incurred while employees are commuting to or from work.
• Workers’ compensation also applies to work-related illness, including those that may develop over a long period, such as those caused by exposure to hazardous substances or repetitive motion tasks. Generally, stress-related physical or mental illness is covered. Stress may stem from a job-related incident, such as a violent attack, a hostile environment, such as one created by some form of harassment, or some type of exceptional pressure related to the work itself or the job environment.
• Finally, note that workers’ comp is no-fault insurance. This means that in most cases it covers even employees who cause an injury. Exceptions may, however, apply to employees who are injured as a result of willful misconduct, fighting, or impairment related to drug or alcohol use.

Make sure you know if your state’s law varies on any of these points.

Cost of Workers’ Comp

Workers’ compensation is a very valuable benefit for employees, but it is a very costly one for the organization. Here’s why:

• Insurance rates are based on a state formula that takes into account statewide accident rates and medical costs, much like any other type of insurance.
• In addition, our workers’ comp rates depend on risk factors assigned to specific jobs—with more hazardous jobs given higher risk ratings.
• Workers’ compensation rates are also based on our claims history. The more claims filed by our employees, the higher our premiums.

Because of these costs, it’s important for you to prevent workplace accidents and injuries so our workers’ compensations expenses can remain low.

Special Provisions

All workers’ comp laws contain two special provisions:

• First, employees covered by workers’ comp cannot sue us for their injuries or illnesses. The only exceptions to this rule apply if we fail to carry required insurance, intentionally cause an employee injury, or retaliate against an employee for filing a claim.
• Second, retaliation is prohibited by law. We can take no action to penalize any employee for filing a claim. You should never do anything to try to discourage an employee from filing a claim. This means employment actions such as demotions, transfers, and termination as well as any form of intimidation, harassment, or pressure—directly from you or encouraged by you.

Filing Claims

When employees are injured on the job, they need to file a claim promptly. Here’s what to do in the case of legitimate—and not-solegitimate—claims:

• Encourage employees to seek prompt medical attention for workrelated injuries and illness. The employee’s recuperation period and the cost of the claim are usually reduced by fast medical attention. Claims should also be filed as soon as possible, which means you need to complete your part in the process right away. Failure to make a prompt report can, in some cases, jeopardize the claim or delay benefits.
• Most claims are legitimate and most employees want to return to work as soon as possible. Unfortunately, there is some fraud in the workers’ comp system as there is in nearly all insurance programs. On the whole, however, your role is to help employees obtain the benefits to which they are honestly entitled and to assist them to return to work as soon as possible. Naturally, if you have any information about fraudulent claims, report this to the insurance company for further investigation. But never take any direct action against an employee who you believe has filed a fraudulent claim.

Make sure you know and follow your organization’s procedures for filing workers’ comp claims.

Reporting Requirements

Once a claim has been filed, here are the reports that must be generated concerning the claim:

• You will probably be involved in writing or collecting information for accident reports, witnesses’ statements, and other documentation relevant to work-related employee injuries and illness.
• Other documentation includes medical reports that detail the diagnosis of the injury or illness and prescribe appropriate treatment. The employee’s physician and specialists will produce these reports, which become part of the employee’s claim file.
• OSHA requires separate forms to report work-related injuries and illnesses. It is important that these be completed and submitted promptly.

Make sure you know which reports you are responsible for filing and what procedures to follow.

Workers’ Comp Basics

• Now it’s time to ask yourself if you understand the information presented so far. Do you understand the purpose and benefits of workers’ compensation? Do you understand the cost issues? Do you know how to file claims and make required reports? It’s important for the financial and physical health of our organization and its employees that you understand workers’ compensation.

Maintaining Contact

You should maintain regular contact with employees on workers’ comp leave for these important reasons:

• Your involvement can help keep up the employee’s morale, as well as the morale of his or her family, during this difficult time.
• Your contact can also help to encourage an employee to maintain the treatment program and rehabilitation or therapy.
• Communication with the employee will also serve as a reminder that the employee is expected back at work as soon as the doctors allow.
• During your conversations with an employee you may also discover that there are problems concerning treatment or benefit payments that need to be referred to the claims manager.
• Finally, your contact with an injured or sick employee demonstrates to the rest of your employees that the organization is concerned for the well-being of all its employees.

Make sure you know and follow your organization’s policy for maintaining contact with employees out on workers’ comp leave as well as for dealing with problems concerning treatment or benefits.

Easing the Return to Work

Now let’s look at how to ease an employee’s return to work after recovering from a workers’ comp injury or illness. Here’s what you need to know:

• Rehabilitation programs help employees regain strength or learn to function with a disability. Therapy teaches employees ways to work without reinjuring themselves or having a relapse of an illness. For example, employees learn proper lifting techniques or stress management techniques.
• Medical professionals will determine when an employee can return to work. Consult with the employee’s doctor to find out whether the employee can return to regular duties or whether a light or alternate duty job is necessary for a while before the employee can take up regular job duties again.
• Alternate duty work helps bridge the gap for the employee between being out of work and resuming regular job duties. The employee’s physician will monitor performance during this period to prevent overtaxing, reinjury, or repeated illness. The physician will tell you when the employee can go back to his or her regular job.
• Finally, note that when there is no appropriate alternate duty job, the employee may be treated solely at an off-site rehabilitation center until he or she is able to return to the regular job.

Alternate Duty

One of the most important ways to ease a recovering employee’s return to work is by assigning appropriate alternate or light-duty work.

• Alternate duty work is a transitional phase for a worker recovering from a job-related injury or illness. It is a way to ease the employee back into work routines without causing further harm.
• Alternate duty work gives the employee the chance to make a meaningful and productive contribution during the transitional phase.
• It is a temporary situation that will end once the employee’s doctor says he or she can resume regular job duties.
• The transitional phase is monitored by medical professionals to prevent reinjury or repeat illness.

Alternate Duty (cont.)

• In addition, this time provides a chance for the employee to rebuild strength gradually.
• Alternate duty work also provides the opportunity for the employee to learn to perform tasks in ways that can prevent future injuries or illness.
• Finally, it is also a morale booster for employees who may be bored at home or fearful about future employment status.

Make sure you know and follow your organization’s specific policy and procedures concerning alternate duty work.

What Alternate Duty Isn’t

Now let’s look at what alternate duty isn’t:

• It is not make-work. It must be real work, something that needs to be done. Make-work harms the employee’s morale and may make co-workers resentful.
• It is definitely not an excuse for the employee to goof off. This would be bad for the morale of the whole work group. The employee must understand that the work is important and that you are counting on him or her to work hard and do a good job.
• It is also not work that could reinjure the worker or aggravate an illness. Consult with a medical professional to design appropriate alternate duty work.

Alternate Duty Suggestions

Here are some suggestions for possible alternate duty jobs:

• Alternate duty work could include less strenuous or stressful parts of the employee’s normal job.
• It could also involve normal job tasks performed on a part-time basis or at a slower rate to accommodate the employee’s recovery.
• Another useful possibility is to combine the less strenuous or stressful parts of several different jobs to create one full-time job for the recovering employee. This could free up other workers to take on special projects or catch up with work that is falling behind.
• Finally, you could decide to assign a special project without a tight deadline to a recovering employee. You probably have several projects that you’d like to get done, but no one ever seems to have the time to do them. This might be an ideal opportunity to proceed with one of these projects.

Permanent Disability

Some disabilities resulting from work-related injuries or illness may prevent an employee from ever returning to work or from returning to the same job. Here’s what you need to know about these situations:

• When employees are permanently disabled and unable to return to work, workers’ compensation continues to provide them with income replacement payments.
• Some permanent disabilities, however, may prevent an employee only from returning to his or her previous job. In this case, we will make every effort to find a job the employee can do, and we’ll provide any necessary training. If there is a difference in pay, disability payments under workers’ comp will make up the difference.

Make sure you know and follow your organization’s policy for providing jobs for employees who are disabled in work-related accidents and are unable to perform their original jobs.

Return to Work

• Now it’s time to ask yourself if you understand the information presented in this section. Do you understand how to maintain contact with employees on leave and ease their return to work? Are you clear about permanent disabilities?

Accident Prevention

In this part of the session, we will look at how you can help prevent workplace injuries and illness so that we can keep our workers healthy and safe and reduce our workers’ compensation costs. Workers’ compensation is an important employee benefit that helps workers who have been injured or become ill on the job cope with their situation and return to work, if possible. But, of course, the ultimate goal is to make workers’ comp unnecessary by preventing injuries and illness in the workplace. Here’s what you can do to help in this effort:

• Conduct regular safety inspections to look for hazards.
• When you identify safety problems, correct them immediately, making sure that your solutions are effective.
• Hold frequent safety meeting with all your employees. Emphasize a broad range of safety concerns and focus on those areas that place your workers at greatest risk.
• Include safety as a factor in performance appraisals. This drives home the message that safety is an important part of the job and that employees will be held accountable for their safety performance.

Consult with your organization’s safety director to make sure you know how to conduct effective and comprehensive safety and health inspections.

Accident Prevention (cont.)

• In addition, many accidents occur simply because of sloppy housekeeping practices. Make sure that your employees’ work areas are kept neat and clear of hazards.
• Make sure that equipment is properly maintained on a regular schedule and that any malfunctioning equipment is removed from service immediately and repaired by knowledgeable and authorized personnel.
• There are many things you can do to encourage employee involvement in the organization’s safety and health program. For example, encourage employees to join safety committees, ask them to help with inspections and training, and invite their suggestions for safety improvement.
• Finally, highlight safety achievements throughout the organization and within your work group. Feature recognition for safety suggestions, keep track of months with no lost workdays, and talk up new safety and health initiatives.

Accident Investigations

Accident investigations also play an important role in preventing workplace injuries and illnesses. Follow these guidelines:

• When employees are injured in accidents or become ill because of their work, conduct or cooperate with thorough safety inspections to determine:

– What conditions and/or actions caused an injury or illness,

– Whether similar incidents have occurred before, and

– What equipment, procedures, and/or training changes could prevent future incidents.

• Furthermore, evaluate situations that lead to stress-related claims and objectively consider:

– Workload, deadlines, and other pressures,

– General morale,

– Other signs of employee stress in the department, and

– Whether your attitude or expectations are contributing to stress.

Accident Investigations (cont.)

• Furthermore, take all necessary steps to correct any conditions that caused an incident. For example, repair or replace equipment, change procedures, conduct training, and reduce workloads.
• Follow up regularly to ensure that corrective action has been implemented and that safety and health conditions are improved.

Make sure you know and follow your organization’s accident investigation policy, including how to fill out the accident investigation report form correctly.

Key Points to Remember

Here are the key points you should remember from this training session:

• Report all injuries and illnesses promptly.
• Help workers file claims.
• Maintain contact with workers on leave.
• Help them make the transition back to work.
• Finally, help reduce claims and keep down costs by promoting safety and preventing accidents.

This concludes this training session.