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Having workers’ compensation is required by law if your business has employees. Having this type of insurance will keep the employees protected in case of any accident or injury taking place at work. If workers’ compensation is not obtained by the employer, then there may be a good amount of repercussions if the company fails to comply, such as being fined daily until compliance is met.

When it comes to your workers’ compensation premiums, there are a few points to keep in mind concerning the premium you pay. By having a clear understanding of each will assist with keeping costs low. Below are the most common things that can have an impact.

The Company’s Experience Modification

This modification is a calculation that the state makes that is based on the history of claims made. This figure includes historical losses that are utilized to have the performance of the company determined.

The average of the industry is 1.0. When it is any higher, then the premiums you pay will be higher.The good thing is that you are able to achieve a lower factor in order to achieve a lower premium seen as a discount. When you’re above 1.0, you will be paying a 10% increase.

Company Payroll

The payroll’s size and employee classification impacts the workers’ compensation premiums directly. In order to be as accurate as possible, a payroll audit needs to be submitted once a renewal of policy is made. If not, then a penalty will be assessed for non-compliance.

When an audit shows that you had a higher  payroll, then the difference will need to be paid to cover the previous revelation. The company may view this as being burdensome, but when the audit is finished, a refund of the premium amount will be provided. Although this may seem attractive, it is a better idea to have the money available whenever you need it.

Decreasing the number of Workers’ Comp Claims

In order to enhance your modification and keep premiums low is to keep the number of workers’ compensation claims down. Regardless of your business, there should be a program in place that helps to prevent work-place injury.

Managing Claims

When a claim is submitted, it can be managed to alleviate the impact on the company. This management can be a game changer. A good example of this is when an injury takes place and the employee returns to work within three days, then the modification will be lower than if there were more than three days involved. When the worker is unable to return to their normal work routine, then they can take on tasks that are lighter than usual while they are recuperating.

If an absence lasts for three days or more, then the modification will be fully impacted, and have a huge effect on the premium payment. It is a good idea to work with the employee’s doctor so that return-to-work can be determined.

Conclusion

When the premiums of workers’ compensation are calculated, the above factors can have a huge influence on it. By keeping on top of the claims and preventing them from happening will ensure that your premium is as low as possible. When you are ready to see how your modification can be impacted, get in touch with us today.

• Posted on: Oct 15 2022
• By: admin

A workers´ compensation settlement case can range between a big amount or a small amount that is dependent upon the injury. Of course, when the injury is not significant, then the claimant can expect a small settlement. But when the injury is significant, then the settlement amount could reach into the millions.

Currently, the most that a workers´ comp settlement has been is $10 million, which took place in 2017. The circumstances surround an employee in California who incurred a car accident while driving home late at night after work. The accident caused the individual to sustain a brain injury that took a huge toll on her life, which she would never fully recover from.

The state of California recognized it to be a workers´ comp case due to the fact that her job required her to complete a project that was completed after working hours.

These types of occurrences happen a lot more than what many realize. It may be a surprise as to who is ultimately responsible if an accident like this took place. However, when you have an experienced attorney, figuring out who is liable can be an easy undertaking, which can allow you to be a good candidate for compensation.

When Exceptions Exist

For workers´ comp to pay a settlement, the injury needs to take place while working and be work-related. This means the employee needs to be providing a service to the employer at the time of injury. This does not normally cover when a commute is taking place. Regardless, the injury that occured was due to a project that required the individual to stay late and finish. Due to the circumstances leading up to the accident, the appeal board for workers´ comp allowed the accident and its circumstances to be valid for compensation.

What Entails a Case For Workers´ Compensation

When it comes to workers´ comp, the insurance provider that covers the employer is liable to pay all claims and benefits for workers´ comp. When a settlement is reached, it is to end the legalities in exchange of a monetary amount that is agreed to. The settlement is normally a lump sum that is representative of the amount of medical expenses that can be expected. When the cash settlement is obtained, then the case is closed indefinitely. This is why it is important to have the most experienced attorney working for you so that you reach the highest amount for your injury.

Amount Of Settlement May Vary

As we mentioned, the amount of a settlement may vary and is based heavily on the circumstances and injury type. The $10 million settlement is the biggest workers´ comp settlement to date. Although every cash amount will be different, your attorney can attempt to get the highest amount possible.

Conclusion

When you give us a call today, we will explain the process of representing you for your workers´ comp claim and what to expect. We will explain the various injuries that can be compensable as well as what their amount could be. So give us a call now to get started.

• Posted on: Sep 27 2022
• By: admin

Regardless of what the circumstances are for your employer going out of business, it is important to know if you will still receive workers´ comp after the fact. Of course, the employer is obligated to provide the insurance, but will the benefits continue once the doors close forever?

Below, we take a look at what happens with workers´ comp when the company goes under.

A Separate Payment System

You are in luck when it comes to collecting workers´ comp payment benefits because the employer is not the one who pays it. In fact, the state you live in has a system designed specifically for workers´ compensation that requires an employer to provide coverage to employees, which a private insurer pays. For the insurance coverage to be valid, the employer will need to pay its policy payments either weekly or monthly. However, when the employer stops making payment on the policy, your benefit payments will continue.

So although your employer covers you while working, they are not obligated to pay for your injury benefits. So when the employer becomes bankrupt, the claim that you are collecting on will not be affected

When the Insurance Company Becomes Bankrupt

If your employer is in business but the insurance company who provides workers´ comp benefits becomes bankrupt, then the employer will need to acquire another insurance provider or be willing to provide benefits out of pocket.

Also, your state will help to get the insurance coverage transferred to a different carrier. If anything, the state may continue to provide the insurance coverage as long as the policy is paid. But who supplies that funding?

When the claims cannot be covered by the insurance company, the remaining assets of the company will be used to make payments. When it comes to workers´ compensation, the payout cap is unlimited.

Things To Keep In Mind

Although your workers´ comp benefits will continue if the business closes, you may still experience issues. The first issue is a delay in payments while your claim is being processed. This delay may also occur when the new insurance provider is getting in touch with the employer to fine tune the benefits and job injury..

The other thing to keep in mind is that the benefits will be dependent upon your capability to work again. When your employer is out of business, they may not be able to verify any specifics. You may see conflicts arise which may affect payments.

Conclusion

When a work injury occurs, a workers´ comp claim needs to be filed. You can rest assured that your payments will continue regardless of your employer going out of business. However, if you have any questions regarding this, then you can give us a call now and we will get it all straightened out for you.

• Posted on: Sep 15 2022
• By: admin

When an injury occurs in the workplace, the way it is handled may differ between employers. However, when the injury occurs due to a common cause such as a fall, slip, or trip, and repetitive stress, then there may be a potential for fraud.

In fact, fraud involving workers´ compensation is a crime that is always investigated. The type of fraud most common among workers´ compensation is known as claim-related fraud. This type of fraud occurs when a claim is falsely made in order to gain benefits through a false injury that takes place while working. When this fraud is committed, the premiums that the employer pays will become higher, which may cause problems for employers who are truly hurt.

Warning Signs Surrounding Workers´ Compensation Fraud

Although it may be difficult to identify true fraud involving workers´ compensation, a few warning signs exist that an employer needs to recognize.

Beginning of the week Injury

An injury takes place at the beginning or end of the work week on Monday or Friday. Usually, an injury occurring on Friday will be reported on the following Monday morning.

The Injury is Reported Late

An injury is reported several days after the fact with no explanation.

A Change in Employment

If the employee experienced a change in employment, such as being laid off or terminated, then you may see a fraudulent claim come up.

Witnesses are Nonexistent

The employee is unable to present witnesses to the injury and the description does not match up with what caused the injury.

Cannot Reach the Claimant

When trying to contact the claimant, they are difficult to reach.

Providers Seem Suspicious

The medical doctor the employee sees has a suspicious history relating to fraud claims.

General Changes

A claimant has made several changes in the past regarding job, address, or doctor.

Refusing Treatment

When a claimant refuses treatment or a procedure to confirm an injury, then it will likely be fraud involved.

Descriptions are Conflicting

When the report of the injury is different from the employee´s description, then there may be fraud involved.

A Claims History

Several claims have been submitted by the employee that seem suspicious.

Past history has shown that if more than one warning sign exists within a workers´ compensation claim, then fraud may be attempted. It is important to remember that these warnings do not mean true fraud is being committed, they are only indications to be aware of.

If fraud is suspected, then it should be reported to the insurance carrier. That way the claim can be investigated by the authorities. Make sure that there is a sufficient amount of evidence that can back the investigation such as witnesses and being able to recognize when misstatements are made.

Conclusion

Having fraud occur within the workplace can become a nightmare for the employer. It can also impact the way legitimate injuries get handled, which can cause delays. This is why you should get a hold of our office today when you suspect workers’ compensation fraud. We´ll get the fraud investigated and the problem resolved so that you can get back to business as normal.

• Posted on: Aug 15 2022
• By: admin

We saw in 2017 how healthcare was tried by President Trump, there were plenty of changes put in place. However, not much has changed as far as healthcare and workers compensation are concerned.

In recent years, workers compensation has continued to model a system that is based on value in order to alleviate high costs and turn towards the workers well-being and health for the long-term.

With professionals in workers compensation and employee benefits, they are needing to be ready for models that are bearing risk.

On a historical level, both payers and providers of occupational health have continued to take the lead. They continue to close any gaps seen among community health and health that is employer-based by integrating practices that are absence management. Having these models allows for the best guidance that is effective and saves costs through the use of guidelines, duration tables, analytics, and modeling that is predictive so that performance can be driven.

No matter what type of program or policy is created, it will become advantageous to use decisions that are based on evidence and methods that are important while the government and employers attempt to  decrease the costs of healthcare as employees attempt to make a healthy recovery.

Workers Compensation Impacted by Plans of Infrastructure and Free-Market

It was believed that workers compensation would be impacted positively in regards to the premiums, which would be based on a plan to improve the infrastructure at a cost of more than $500 billion that would be in support of waterways and roadways. Even so, there still remain many questions of how the changes would make an impact. A good example of this is if a worker is able to obtain coverage through workers compensation the same way as they were before.

With workers compensation law, each state manages them at their own level, which only causes an indirect impact. In addition, the changes in immigration law have also affected the way states handle undocumented immigrants who file for workers compensation.

Care That is Value-Based

In order for the workers to get the care they need, a provider will be using the tools designed for care that is value-based so that they are in compliance with the platform of healthcare established by Trump. With a significant amount of support for prices and empowerment among consumers, the outcomes of clinical performance will remain a main concentration for the future. In reality, the groups who lead the healthcare industry are all in agreement that the MACRA will continue to be unaffected  and will help advance models that bear risk.

In actuality, the efforts continuing today will likely continue to create risk. An example involves  how organization penalties occur due to not participating fast enough in which the law requires for Quality Payment Programs.

For the moment, initiatives exist that have shifted the cost burden away from employers and to networks, which will need quicker activity return.

What We Can Expect

As we continue to see changes evolving around workers compensation, both employee and provider needs to remain determined in order to be prepared for care that is value-based while taking advantage of tools which will continue to help the patient reach their full recovery. If you wish to find out more about how your workers compensation is affected by Trump policies, then call us now.

• Posted on: Jun 30 2022
• By: admin

When an injury occurs while working, the employee is entitled to workers´ compensation. These benefits cover any employee who is injured and suffers an illness related to the injury. To be eligible for the benefits from workers´ compensation, there are some requirements that must be met. First, there should be workers ‘ compensation insurance covering the employee, you work directly for the company, and you have sustained an injury at the time that you were working.

Law Governing Immigration Reform

Known as the IRCA, the Immigration  and Reform and Control Act oversees immigration in the United States. With close to 5% of the countries population being undocumented, that is a lot of unauthorized workers living within. Under the Immigration and Reform and Control Act, it makes all employers check the immigration status of all potential new hires to ensure that they are authorized to work legally. If an employer violates the IRCA law, then they could face a financial penalty of at least $10,000. This amount is on an individual basis and can quickly add up if there are several undocumented employees.

There have been many situations occurring where an injury occurs to an undocumented employee while working and the employer will make attempts to enforce IRCA in order to deny any benefits that may be warranted by an injury. In fact, the argument made stems around the fact that the employee is not legally authorized to work for the employer, so they feel they are not obligated to provide benefits.

What Do The Individual States Say?

There are quite a few states who have written laws that permit undocumented workers to obtain benefits from workers´ compensation. These laws are governed under a statute that specifically outlines employees who are undocumented. A few of the states that implement statutes include Texas, Colorado, Tennessee, California, Arizona, North Carolina, and Hawaii.

With immigration being a huge factor, there is always something going on that gets covered by the news. Not only that, but legislation may come up again where immigrants working illegally will become barred from obtaining workers´  compensation.

In times that are even more recent, the issues of immigration were brought up when Central Americans reached the border. Because of this, many residents of a town decided to prevent  government buses carrying the immigrants to make their way through town.

Another instance occurred in 1999 when a Supreme Court ruling in Virginia ruled that no workers compensation may be obtained by undocumented workers if they sustain injury. Because of this, many employers decided to back laws that supported undocumented immigrant workers and their ability to obtain benefits. With that, it is clear that many attempts have been made to make it illegal to provide workers compensation benefits to a worker who is undocumented. However, the laws in each state continue to be the same.

Conclusion

There is a lot to know about immigration and the fact if an undocumented worker is eligible for benefits. That is why you should contact us to go over what your state laws say about it. This way you will be more informed about what course to take.

• Posted on: Jun 15 2022
• By: admin

Many courts continue to struggle to decide if the cost of medical marijuana should be covered by worker’s compensation. In fact, many courts are ruling for the costs to be covered and having the injured compensated for reimbursement of medical marijuana purchases and to cover costs in the future.

Not only that, but many state supreme courts are also ruling to allow medical marijuana to be covered and reimbursed for injuries reported to worker’s compensation. Plus, with many states adopting medical marijuana as a law, many states require that it be covered. Despite this, there are some states that do not require medical marijuana to be covered and do not mandate the reimbursement of costs. Within Pennsylvania, an initial ruling allowed medical coverage, while a bill has been floating around that would not require the coverage of medical marijuana.

Other states have tried to deny the coverage of medical marijuana and any reimbursements but only failed in the process. Within Alabama, a law exists that protects an employer and its insurers from covering medical marijuana along with any reimbursements.

Determining Under the Influence

When it comes to determining if worker’s compensation will be approved, it must be determined if a worker was under the influence at the time of injury. Many standards are set in place that can recognize whether under the influence took place. However, each state has different standards. Other differences involve other impairments and intoxication indicators. This is making states consider whether an impact is made on marijuana that has been legalized for workers’ compensation purposes and the way to decide if marijuana intoxication has taken place.

With the introduction of legislation covering intoxication standards, it will be hard to tell if intoxication is taking place and how an impact could take place for workers’ compensation benefits when an employee was considered as being impaired while getting injured on the job. There is even some legislation that if an individual is refusing a drug test or fails a required drug test, then it can be assumed that impairment had taken place. Some states have exclusions for this type of legislation which covers medical marijuana.

Current law in North Dakota allows for a rebuttal that presumes marijuana caused an injury if the limit is a certain amount during a drug test. A refusal to take a drug test automatically denies a workers’ compensation claim. In Nevada, a law exists that covers the standards of under the influence of any controlled substance as well as marijuana for the purposes of workers’ compensation. An exception exists for those who have a medical marijuana prescription that is legal and current.

Conclusion

While medical marijuana has been a huge debate for being covered by workers’ compensation, the fact remains that the ultimate decision for coverage is left to the courts. If you feel like you should be covered by workers’ compensation for your medical marijuana, then you need to get a hold of our office today.

• Posted on: May 24 2022
• By: admin