How to know if your workers’ comp claim is compensable

Workers’ compensation insurance can be a real lifesaver for a business if an employee gets hurt or becomes ill because of their job. It’s a way to protect them and make sure that they’re provided for if something happens to them on the job. Safety should always be a priority at the workplace – along with helping you and your employees avoid injuries, this will help you lower your workers’ comp premiums as an added bonus.

Anyways, if something happens on the job, you may not necessarily be to blame for the accident or injury, but you were the one requiring the employee to be there. Thus, workers’ comp insurance is there to take care of your responsibility to the employee. If you’re in the position of handling a workers’ comp claim and you’re not sure if it’s going to “count” as a claim, keep in mind that there are a few criteria to be met for a claim to be compensable. (Compensable basically means that the employee is eligible to receive workers’ comp benefits because of their injury.)

So, what are these magic criteria, you may ask?

We’ve broken the requirements into three questions below to help you figure out where your workers’ comp incident stands.

1. Did the injury or illness result from the employee’s job for your company?

For a workers' comp claim to be compensable, the injury has to have happened as a result of the employee's job.

Workers’ comp isn’t just good for accidents or injuries. It covers workplace illnesses, too, meaning that if an employee’s job causes them to become ill, it’s a compensable workers’ comp claim. But it has to be directly related to their job environment and what they’re doing to further your business’s gains.

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Not only that, the workers’ comp claim must have resulted from the employee’s desire to benefit your business or help you as the employer gain in some way. That gain could be financial, of course, but not necessarily—not everything comes back to money! Hard to believe, but true. Anyways, if there’s a connection between the employee’s responsibility or desire to benefit the business and their injury or illness, it could be a compensable claim.

2. Did the injury or illness happen on the job?

If you required the employee to be at a certain place, the workers’ comp claim can be compensable. However, the employee must be able to show that they were actively contributing to the business when the injury occurred. They need to have been working and furthering your interests.

There’s a “coming and going” rule when it comes to workers’ comp that means that if the employee was injured while going to or from work they aren’t eligible for workers’ comp benefits. But if the employee is traveling from one job site to another for work and is injured as they’re doing so, that claim could be compensable. It gets a little complicated.

A workers' comp claim has to have happened on the job.

3. Did the injury/illness result in impairment or lost wages?

To receive workers’ comp benefits, the employee must have lost wages due to their injury and subsequent inability to work. Or, they must have some kind of impairment due to the injury—even if they can still receive wages, they may still be eligible for workers’ comp aid. So long as one of the conditions—impairment or loss of wages—is met, the claim could be compensable.

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So, as you can see, just because a workers’ comp claim arises it doesn’t mean that it’s going to be compensable. There are factors to take into account and criteria that must be met. It’s important that you understand when and why a claim is compensable, and that you can explain it so that it’s also clear to your employees. It helps to be on the same page with the people who are affected. And remember that it’s important to report your workers’ comp claim quickly.

If you have any questions about your business insurance coverage or if you’re in need of workers’ comp insurance, give us a call or fill out our online quote form! We can help you fulfill all of your insurance needs, and we can even get you a free quote for your workers’ comp. Sounds good, huh?