Workers' Compensation Claims
While the coverage included in any Workers' Compensation policy is largely
mandated by state statute, Kelly Mayerle distinguishes
its policy by going beyond those requirements to expand coverage in several
key areas. Better yet, we complement those expanded coverages with exceptional
claims handling and a variety of cost containment services.
What Is Workers' Compensation - And Workers' Compensation Insurance?
In general, the current Workers
Comp system represents a compromise between employers and employees
regarding employment-related injuries or illnesses. Basically, employees
relinquish their right to sue employers if they suffer some job-related
injury or illness. In return, employers agree to provide state-mandated
benefits if such injuries or illnesses occur.
To ensure employers will have the money to pay these mandated benefits,
most states require that employers demonstrate that they have the financial
ability to pay any claims that may arise. Typically, this financial ability
is demonstrated through the purchase of Workers' Compensation insurance.
Most Workers' Compensation insurance policies actually provide two types
of coverage:
- Workers' Compensation Coverage. Pure Workers' Compensation coverage provides benefits for injured workers as required
by state law -- regardless of who is at fault for the injury or illness.
In other words, whatever benefits your state requires that employers
provide for injured workers, your Workers' Compensation policy provides.
- Employer's Liability Coverage. This additional coverage provides
employers with liability protection in case they are ever sued for
damages arising from employment-related accidents or diseases. However,
to collect benefits provided by Employer's Liability Coverage, both
the employee as well as anyone else not covered by workers
compensation laws (i.e. spouses and dependents), would have to prove
that the employer was actually legally responsible for the employee's
injury or disease.
Who This Policy Will Cover?
In general, Workers' Compensation insurance is designed to provide benefits for your employees.
However, the individuals that are defined as employees are determined
by state law. And in Workers' Compensation cases, courts have typically
been very liberal in their definition of employees, so as to provide injured
workers with broad protection under the state's Workers' Compensation laws.
The Employer's Liability insurance included in your Workers' Compensation
policy can also provide damages to injured workers separate from their
Workers' Compensation benefits. Family members and other third party claimants
may also receive benefits under this coverage -- if they prove the employer's
legal liability.
What Expenses This Policy May Pay?
Typically, your Workers' Compensation policy will pay for:
- Medical benefits for a covered injury or disease -- including medical,
hospital, surgical and other related health care costs as well as physical
therapy and prosthetic devices
- Disability income benefits - including compensation for lost wages
- Rehabilitation benefits - including services to help an injured worker
return to productive work, such as vocational rehabilitation
- Death benefits - including a flat amount for burial expenses as well
as partial replacement of the worker's weekly wage.
What Protection This Policy Offers?
Work-Related Injuries
If one of your employees is accidentally injured while on the job, your
Workers Comp policy will pay for a wide range of services to aid the injured
worker's recovery and return to productive work. These services can include
the cost of medical care, compensation for lost wages, and rehabilitation
therapy.
If your employee is accidentally killed while on the job, your policy
will also provide death benefits -- including burial expenses and partial
replacement of the worker's weekly wage.
Occupational Illnesses
If some condition in your working environment actually causes one of
your employees to become ill or contract a work-related disease, your
Workers' Compensation policy will provide a wide range of benefits to help
treat this illness and speed the employee's recovery. These benefits will
typically cover the cost of medical care, compensation for lost wages,
and other required therapy.
If your employee dies from this disease, your policy will also provide
death benefits -- including burial expenses and partial replacement of
the worker's weekly wage.
Coverage for Employees Not Subject to Workers' Compensation Laws
Most Workers' Compensation policies only provide benefits for those employees
your state specifically identifies as subject to workers' compensation
laws. But some policies goes beyond this requirement. It automatically
extends bodily injury coverage to employees who aren't expressly covered
by your state's Workers' Compensation laws -- such as volunteers. (Not
available in Wisconsin and New Jersey.)
Liability Suits Related to an Employee Injury
To recover benefits under your state's Workers Comp law, your employees
don't have to prove you were somehow responsible for their employment-related
accident or disease. But if they can prove you were liable for their accident
or illness, they may be able to successfully sue to recover damages beyond
the Workers' Compensation benefits.
If so, you'll be comforted to know that the Employer's Liability portion
of your Workers' Compensation policy can pay for the damages awarded to
your injured employee -- as well as the legal expenses involved in such
a suit. This coverage may also provide certain benefits if you are ever
sued by a third party affected by a workplace injury, such as a family
member of the injured worker.
Expenses You Incur as Part of a Workers' Compensation Claim
If you are ever involved in a Workers' Compensation claim, proceeding,
or suit, most Workers' Compensation policies will pay for any reasonable
expenses you incur at our request to participate in these proceedings
or help prepare your defense. In fact, we'll even pay for any earnings
you lose because of these activities -- a benefit most standard Workers' Compensation policies do not offer.
Legal Expenses in Workers' Compensation Cases
If you are protected by Workers' Compensation policy, you generally won't
have to worry about bearing any legal expenses related to a Workers' Compensation
or Employer's Liability claim. In fact, we will assume the responsibility
of investigating, defending and settling any related claims, proceedings
or suits. We will also supply the services of an attorney to represent
you in any such suit. In short, we will:
- Pay the cost of defending you in any hearings, suits, etc, that result
from any occurrences covered by Workers' Compensation; and
- Pay damages if you are successfully sued because of a job-related
injury or disease.
Compensation for Family Members
If an injured worker's family members can prove that you were legally
liable for a work-related injury or illness, they may be able to collect
damages from you. In such cases, the Employer's Liability coverage provided
by your policy may pay for:
- compensation for family members for their "loss of consortium"
or access to the injured worker; and
- damages for injuries to spouses or relatives that result from the
injury to the spouse or relative.
Coverages for Employees While Traveling on Business
Most Workers' Compensation policies only provide coverage for the states
in which you do business, as specified in your actual policy. Therefore,
check your policy if it extends its Workers' Compensation coverage to employees
traveling outside the standard policy territory (excluding U.S., Canada,
Cuba, Iran, Iraq, Kampuchea, North Korea, Libya, and Lebanon).
Accidents Over Navigable Waterways
If any of your employees ever have an accident while carrying out their
job responsibilities over a navigable waterway, they may be subject to
the workers' compensation benefits provided by the United States Longshore
and Harbor Workers' Compensation Act. Typically, benefits mandated by this
act are more extensive than those provided under a state's Workers' Compensation
law.
Employer's Liability in Monopolistic States (NV, OH, WA, WV, WY)
In six states, the state governments mandate that employers purchase
Workers' Compensation insurance from the state fund. Referred to as "monopolistic
states", these states don't even allow insurance companies to sell
Workers' Compensation to employers headquartered within their borders.
Even if your business isn't domiciled in one of these states, you could
still be affected by their laws. If one of your employees is injured in
any of these states and decides to file a Workers' Compensation claim,
that state's laws would apply. In such a situation, you'll be reassured
to know that most Workers' Compensation policies automatically provide
"employer's liability" coverage. This coverage would pay for
related expenses and damages in case you are ever sued for the employment-related
injury or illness. Other insurers may offer this extended coverage in
these states -- but only if you specifically request that they add it
to your policy.
Third Party Suits Against the Employer
If your employees are injured in an accident, they may try to sue a "third
party" (a company other than yours) -- if they believe that party
is somehow responsible for their injury. In turn, that third party may
sue you -- if it believes your company is legally liable for the accident.
For example, an employee injured while using a piece of equipment may
sue the equipment manufacturer for some alleged negligence or faulty design.
However, the manufacturer can then turn around and sue your company --
if they believe the accident was instead caused by your improper maintenance
of the equipment.
In this situation, the Employer's Liability coverage of your policy would
pay any damages awarded by the court to compensate for the bodily injury.
Failure to Notify Insurer of Potential Hazards
When you apply for a Workers' Compensation policy, you have an obligation
to disclose to the insurer all known hazards. But what if you don't even
know you have a potential hazard at your business site? Unlike other policies,
our Workers' Compensation policy explicitly states that we won't deny coverage
if something happens as a result of that undisclosed hazard -- as long
as you did not intentionally fail to notify us of its existence.
Investigation into Workers' Compensation Fraud
Unfortunately, fraudulent claims add to every employer's workers' comp
costs. And since most insurance companies are serious about helping you
control costs, we're serious about fighting fraud. Our claim professionals
can also coach you on how to spot and handle a potentially fraudulent
claim.
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