Defending Workers' Compensation ClaimsHR Resource
February 6, 2013 — 1,944 views
If you are a worker comp manager, then you would be aware of the fact that the possibility of the employee getting the compensation claimed is greater in some cases than others. Therefore, there are a few cases that always work in the favor of the worker comp manager when they are defending claims. The factors that help in deciding which claims should be defended and which ones should denied are mentioned below.
Reasons for Defending or Declining the Claim
The primary reason on which a worker's compensation claim should be defended or denied is the authenticity of the cause for the claim. If the worker is injured while performing a given task in the organization, and if the policy of the company states that he has the right to be compensated, then the claim should be defended. However, if the worker is associated with an organization where the policy does not include compensation, or if the worker has not been injured while completing a task at the office, the claim should be declined. Some workers make claims for injuries that may have been caused due to personal reasons. So as a worker comp manager, you should verify your facts before defending or declining any claim.
WC Claims That Should Be Defended
As a WC claims manager, it is advisable that you defend a claim in a situation wherein the employee's firm treats the compensation claim like an insurance. Many companies treat workers' compensation like a type of insurance. For instance, according to Maryland's present law system, all the employers in the region are required to purchase a specific workers' compensation insurance policy from a particular provider for all their employers.
So in such a system, the employers buy the compensation like any other type of insurance and pay a fixed premium for it every year. So the entire cost of the workers' compensation is borne by the employer. As a worker comp manager, defending a compensation in such a set-up would prove to be beneficial for you because the likelihood of the employee getting the claim is way higher than a regular situation. Therefore, you can make the claim through a basic procedure.
Claims that Should Not Be Defended
In many cases, the employers have a very strict policy with regard to compensation. Such employers need to bear the cost of the compensation on their own, so they have very strict policies towards it. In most cases, they also have letters of instructions that state that the company is not responsible for all types of injury that the employees face during the job. So they limit their compensation to a particular set of injuries.
Therefore, as a worker comp manager, you need to be very careful in analyzing the injuries in such instances, and evaluate whether or not the employee can get a claim. If you feel that the company's policies lower the chances of the compensation, you should deny filing for claims in such instances.