Jack and Carol work for the same construction company. While working on a new home, Jack hurt his back. He’s now out for several weeks while still drawing some salary. Carol, who manages the office, caught a cold. She’s also at home but using sick leave to pay the bills. Why is the difference?

That difference comes from today’s topic: workers compensation benefits. Covered not only what it is, but who qualifies, how it’s administered, and how participating providers and their technology can make the best use for this important program. 

What Is Workers Compensation Benefits: An Overview

Workers compensation benefits are various forms of aid provided to workers injured while in the course of performing work-related duties. It is also known as workers compensation insurance or, more commonly, as “workers comp” 

Benefits include:

  • Any cost for re-training
  • Compensation for any permanent injuries
  • Income while recovering from injury or illness
  • Medical care addressing the injury or illness
  • Rehabilitation expenses
  • Survivor benefits to survivors of workers who are killed on the job

The exact benefits depend on the state (see below). Note worker compensation is not the same as unemployment benefits or disability insurance.

Workers comp is mandated by the federal government. Employers by law are required by law to provide it. Unlike Social Security benefits, funding for the program is not deducted from the employee’s pay. Instead, most workers’ comp benefits are handled like insurance with the benefits covered by private insurers. 

Each state in the U.S. handles it differently. Most only make it available to salaried employees. And who is an “employee” can vary greatly. For example:

  • In Alabama, farm laborers do not get workers comp. 
  • Licensed real estate brokers and Some sports officials do not get benefits per the state of Florida.
  • Petroleum land workers or workers operating within a Native American reservation in Montana do not qualify for benefits.  

State departments handling workers comp claims go by such names as Division of Workers’ Compensation (California), Georgia State Board of Workers’ Compensation, Industrial Commission (Idaho), and Employment Standards Division (Montana). 

Unsurprisingly, independent contractors, sole proprietors and business partners, and casual employees (that is, temporary employees aka “temps”) do not qualify for benefits. 

Two states are notable. Both Kansas (Department of Labor) and Ohio (Bureau of Worker’s Compensation) seemingly require workers compensation insurance for all employees engaged in some form of legal labor. 

The federal government, through the Federal Employees’ Compensation Act (FECA), provides various workers comp benefits to its employees. Federal programs are also available for longshore and harbor workers, employees engaged in the energy sector, as well as coal miners and their dependents (Black Lung Program). 

How Does an Employee Qualify for Workers Compensation Benefits

Qualified workers receive workers comp for injuries: 

  • Occurring at the workplace during business hours
  • Performing work-related duties while off-site 

What qualifies as an “injury” varies. Some of the most common workers compensation claim injuries include:

  • Burns
  • Contusions
  • Cumulative or continuous trauma
  • Eye injuries
  • Fractures
  • Lacerations
  • Sprains and strains

Issues that are not covered by workers compensation:

  • Act of God (injury from a storm)
  • Ordinary and common illnesses like colds
  • Pre-existing condition(s) like birth defects or diabetes 

Providers and Employees with Workers Compensation Benefits

Qualified workers, after being injured, have a limited window of time to report their injury to the workplace and file a workers comp claim. Depending on the state, the worker may:

  • Need to undergo an independent medical exam, or IME. This is an entirely separate process from treatment of the injury by the worker’s primary care physician (PCP).
  • The IME may be conducted by a provider selected by the employer’s insurance company. 
  • The insurance company may choose the doctor you see for the IME. Some states may allow employees to choose from their “preferred provider plans.” Others, though, have a state-approved list. 
  • Some states allow patients to choose their PCP as long as they are a) qualified with dealing with workers comp, b) approved by the state’s Workers’ Compensation Board, and c) have been pre-designated by the employee. 

Providers performing the IME as well as treating work-related injuries are usually experts on worker’s compensation cases. They make the medical determination for the worker’s eligibility for workers’ compensation and benefits. This includes:

  • Additional treatment for the foreseeable future
  • Extent and scope of treatment
  • If the injury is temporary or permanent
  • When to release them from medical care

To simplify their important tasks, their medical computers should:

  • Be optimized for their electronic medical records program. This makes it vastly easier to pull up the patient’s personal information, health status, test results, and treatment plans. 
  • Have security features like built-in RFID reader for signal sign-on identification from ID-software like Imprivata. This keeps the patient’s records safe and secure.  
  • Be of fanless design and IP65 rated. Computer equipment like medical tablets are touched by many hands. PCs that are fanless do not take in air to stay cool while the IP65 rating means they are sealed from most liquids. Medical staff can use hospital grade cleaners on them without concern of damaging the more delicate interiors. 

Closing Thoughts

Workers compensation benefits provide medical care, treatment, any necessary training as well as cash benefits like income for workers injured in the course of performing work duties. Though mandated at a federal level, who qualifies for the benefits, requirements, and the process itself is determined at a state level through workers’ compensation department. 

Contact an expert at Cybernet if your medical practice is involved in seeing workers comp cases and how medical computers can make the determination process more smooth and efficient for those injured. 

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