As an employer, the law requires you to provide adequate workers’ insurance coverage to all of your employees, with some exceptions depending on your state laws. It’s also your responsibility to inform your workers of their rights and what benefits they would receive after a work-related injury or if they develop an occupational illness.
When discussing coverage details with your employees, you may get some questions you don’t know how to answer. For example, what should you tell an employee who inquires about agitation to a previous injury? The answer to this question depends on circumstance-specific variables as well as state laws and regulations. To be prepared for questions related to workers’ compensation insurance classification and pre-existing conditions and to understand precisely what you’re paying the insurer for—you’ll want to do a little bit more digging into the subject.
Workers’ Comp Coverage Basics
When a covered employee sustains a work-related injury or develops an occupational illness, the company’s workers’ compensation insurance covers the medical expenses and lost wages.
Workplace injuries can include anything from a small mishap, such as a slip or fall, to severe circumstances like amputations. In the case of a fatality, the insurance provides death benefits. Examples of illnesses caused by work conditions include hearing loss, cardiovascular or respiratory conditions, and even cancer.
How it Works: Workers’ Comp Care
When an employee sustains an injury or gets diagnosed with a medical condition that traces back to their workplace, they should first inform you, the employer. Your primary responsibility is to provide the employee with the information and paperwork they need to file a claim with the insurance company. You can click here to learn what to do when there’s an employee injury at work besides facilitating the claims process.
If the insurance policy provider accepts the claim after a thorough investigation, they offer the worker compensation for emergency and ongoing care expenses and salary replacement. However, if the employee disagrees with the compensation package offered, they can pursue a workers’ comp settlement.
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When Current Work Worsens a Pre-existing Condition
A pre-existing condition is an illness or injury that affects a person’s overall health and performance, especially in the workplace. In the context of business insurance, there are two different types of pre-existing conditions, depending on how and when an employee’s injury or occurred or when the symptoms of their illness first manifested:
Pre-existing Condition from a Previous Workers’ Comp Claim– This is an injury, ailment, or illness that the employee suffered because of work at a previous job, making it an industrial injury.
Pre-existing Condition Unrelated to Previous Work– This type of condition is entirely independent of the employee’s current and former work experience. For example, an injury sustained on vacation five years before accepting the job would be considered an unrelated pre-existing condition.
Pre-existing Conditions and Workers’ Comp Settlements
Though the laws and regulations vary from state to state, employers and their insurance policy providers are generally only responsible for workplace injuries and illnesses that occur while the employee performs work-related duties for their current employer.
However, the rules aren’t so cut and dry when an employee’s current work agitates or worsens a previous injury or condition. When the injured or ill employee submits a claim, the insurance provider has to investigate whether the work-related injury directly worsened the pre-existing condition or injury symptoms or if the two are entirely unrelated. This determination is especially difficult when the pre-existing condition and the new injury affect the same area of the body.
In these situations, the workers’ compensation claim often leads to negotiation and settlement between the worker’s attorney and the insurance company. Often, a third-party medical professional conducts an exam and reports their findings to the legal representatives. Whether or not the new injury agitated a previous condition, the insurance provider still must pay compensation for the treatment associated with the new injury.
Educating Employees on Insurance Issues
Preparing for the rare occasion of a workplace injury or illness that includes a pre-existing condition can be time and resource-consuming. However, it guarantees that neither you nor your employees are at a disadvantage in the case of an accident. Understanding how this type of compensation generally goes and what your options may come in handy later on. Furthermore, understanding the ins and outs of your workers’ compensation coverage prepares you for the questions and concerns an employee will likely raise down the road.
