What Employers Need to Know About Workers Compensation

What Employers Need to Know About Workers’ Compensation and Job Related Injuries CONTROLLING YOUR FINANCIAL AND HUMAN COST This Photo by Unknown Author is licensed under CC BY-SA-NC 1

Workers’ Compensation for Texas Employers • A state-regulated insurance program • Not mandatory except for certain governmental entities, educational institutions, and for certain private employers as required by law 2

What Workers’ Compensation Does • Reasonable/necessary medical treatment – lifetime medical for injury • Weekly income replacement benefits • Death and Burial-beneficiary benefits • Impairment and Lifetime benefits • Dispute resolution • Carrier/TPA pays & manages • No fault – No blame • Protects Employer • Protects Employees 3

Non-Covered Employers • Other insurance programs available • They are NOT the same as Workers’ Compensation • Not likely to pay for litigation • Legal Fees • Punitive Damages • Court costs • Pain and Suffering 4

Non-Covered Employers Required Reporting • Annual Notice of non-coverage to employees and TDI • Notify TDI if employer drops coverage • Notify TDI if injury results in lost time or death • May be fined for not filing • Forms available on line at www. tdi. texas. gov/wc/index/html 5

Your Workers’ Compensation Premium • Industry • Payroll • Past experience (cost) = Your Experience Modifier Fewer injuries and eliminating unnecessary lost time mean lower costs 6

Controlling Your Costs COST SOLUTION • Severity of injuries • Frequency of injuries • Safety culture & training • Enforcement & Accountability • Medically unnecessary lost time 7 • Stay at work • Return to work Your trained experienced employee continues to work while recovering

THE GOAL IS TO HELP INJURED EMPLOYEES RECOVER AND GET BACK TO WORK AS SOON AS POSSIBLE AFTER AN INJURY. IT IS A RESPONSIBIITY SHARED BY EMPLOYERS-EMPLOYEES-HEALTHCARE PROVIDERS INSURANCE CARRIERS - DWC 8

Benefit to Employers • Reduce costly turnover & training costs • Reduce absences • Maintain quality and production standards • Reduce workers’ compensation and business costs • Pay wages for work – not benefits Employees heal better and faster 9

Benefit to Injured Employees • More likely to retain job related benefits • Avoid financial difficulty • Keep job skills up to date • Avoid becoming isolated, depressed • Stay in better physical and mental condition 10

• Heal better and faster • Remain employable • More likely to keep their job 11

Medically Unnecessary Time Off Work • Personal reasons • Family problems • Fear • Just don’t wanna • My job • Work environment 12

Employers and Unnecessary Time Off Work • No work available • Have to be 100% well • Too busy • Insurance carrier’s job • Supervisors, managers 13

Employer’s Role • Post notices of coverage • Inform employees • Report injury to insurance carrier • First Report of Injury/Wage Statement • Investigate • Monitor claims regularly • Talk with the doctor • Maintain communication 14

• Attend hearings • Provide RTW opportunities Employers Don’t: • Determine compensability • Direct medical • Networks • Can develop medical relationships 15

Insurance Carrier-Adjuster • Adhere to all rules and laws • Investigate to determine compensability • Monitor claim activities • Maintain communication with injured employee and employer-doctor-other providers • Information and education • Use Treatment and Lost time guidelines • Return to work coordination services • Possible case management 16

Treating Doctor’s Role • Provide medical care for injury • Identify any restrictions and establish possible duration • Communicate • DWC – 0073 Work Status Report • Provide to injured employee, employer and insurance carrier • Support SAW/RTW efforts 17

SAW and RTW NOT: “Light Duty”- REAL WORK! Tasks – Duties- Activities Booklet available with information to help you manage your workers’ compensation and RTW activities 18

Making SAW & RTW Work • Change expectations before another injury • Educate and inform – remove surprises • What to expect and what to do • Your policies • Contact person – “Who you gonna call? ” • Continuous positive communication with injured employees • Involve your employees 19

Help for Small Employers from DWC • For private employers • 2 to 50 employees • Equipment, worksite modifications, tools, devices, etc. • Reimbursement, preauthorization & advances • Up to $5000 • Application : www. tdi. texas. gov/wc/index/html 20

Real Work Assignments • Within Restrictions • Transitionary-temporary • Their regular job • New assignment • Tasks – functions - duties • Different way of doing something 21

Value of Part-time work assignments • $500. 00 Employee’s AWW • $500 X 70% = 350. 00 Weekly Benefit ************************ • Employee returns to work 4 hrs • Earns $250 working for employer • $250 X 70% = $175 New Weekly Benefit 22

From the Division of Workers’ Compensation (DWC) • SAW/RTW seminars, consultations, training – for employers, adjusters, health care providers • Employer Reimbursement Program • Safety and health Services – DVD’s/Publications • OSHCON • Field Offices • Dispute resolution • OIEC to assist injured employees 23

Pat Crawford pat. crawford@tdi. texas. gov 512 804 4683 More information at www. tdi. texas. gov/wc/index/html 24