Magazine article Occupational Hazards

Explaining Workers' Comp to Supervisors: Setting Aside Some Time to Explain to Supervisors the Fundamentals of the Workers' Compensation System Is Time Well-Spent

Magazine article Occupational Hazards

Explaining Workers' Comp to Supervisors: Setting Aside Some Time to Explain to Supervisors the Fundamentals of the Workers' Compensation System Is Time Well-Spent

Article excerpt

Safety professionals have heard it before: "Why are we paying workers' comp on this person?" Management might ask this question for a number of reasons, from concerns about fraud to frustrations that the injury was the result of the worker's own negligence. When dealing with management--especially supervisors--it seems that safety professionals often spent a great deal of time trying to explain that regardless of the circumstances, workplace injuries are compensable.

It can be frustrating for safety professionals when supervisors don't understand how the workers' compensation system works; compounding the problem is that the workers' comp system is not intuitive. To ease this frustration, some organizations have found value in providing training to the supervisory staff on the fundamentals of the workers' compensation system. Another benefit to providing such training is that by explaining the system to supervisors--who are the main points of contact with employees--they are more attuned to issues that might affect a workers' compensation case.

Topics to Cover

When educating supervisors on the workers' compensation system, several important topics to cover are: fraud; the no-fault nature of the workers' compensation system; what is compensable; and the sometimes-confusing lexicon associated with workers' compensation claims.

1. Fraud

It is a fact of life that workers falsely file workers' compensation claims to assure themselves wage replacement while recuperating from a non-work-related injury or to secure cash payouts. While workers' compensation fraud is an issue, and much investigation time is spent on such claims, it is not a prevailing factor in workers' compensation claims.

Part of the issue with workers' compensation fraud revolves around the false perception that fraud is much more prevalent than it is in reality.

Some studies estimate that 5 to 20 percent of all workers' compensation benefits paid are fraudulent. These numbers are disputed, and it's unknown just how many fraudulent workers' compensation claims are filed or how much these fraudulent claims cost employers. Most states will express fraud as an amount of dollars saved through investigation recovery.

To counter arguments concerning the prevalence of fraudulent claims, some facets of the workers' compensation and fraud systems must be understood.

Fraud Is a Broader Issue

Workers' compensation fraud occurs when a person knowingly or intentionally conceals, misrepresents and makes a false statement to either deny or obtain workers' compensation benefits or insurance coverage, or otherwise profit from the deceit. The key to conviction is proving in court that the misrepresentation or concealment occurred knowingly or intentionally.

By this definition, fraud can be an employee misrepresenting an injury, a health care provider that bills the workers' compensation insurance provider falsely or an employer that misrepresents the number of employees (which results in lower billings). All of these are fraud.

When a workers' compensation system (state, self-insured or private firm) reports savings from fraud recovery, it is including all three forms of fraud.

2. A No-Fault System

Workers' compensation is a no-fault system. In other words, if an injury occurs in the workplace, it is compensable regardless of the employee's actions. An injured worker is eligible for workers' compensation even if the injury is a direct result of the worker breaking safety regulations or deviating from procedures. …

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