As a business owner or leader, you never want to hear, “an employee is injured.” So, when you do hear those words, what do you do?
In this short article, we are going to cover the steps necessary to ensure you have an effective process in place if/when an employee is involved in a workplace accident, injury, or illness. By establishing a process before the need arises, you will be able to facilitate the care for employees and stay compliant throughout the event.
First and foremost, as a Leader it is imperative that you identify a partner in providing care for employees. Establish a relationship with your local Occupational Healthcare facilities or Urgent Care/Emergency Treatment Providers in your area. Set up an account and provide them with all of your Worker’s Compensation Insurance information. This makes the billing process much easier for your administrative team as well as the injured employee.
Next, train your leadership team and front line managers to know how to assess the employee’s required level of care. If they are experiencing life threatening emergencies, dial 9-1-1.
If injuries are non-life-threatening and you know they need care but are unsure of what kind of care might be needed, you have a couple of options.
Option 1: Many workers’ compensation carriers offer 24-hour access to registered nurses who are specially trained to offer medical guidance. If your carrier offers this, reach out to them for assistance. If not, follow option 2.
Option 2: Send the employee to a local Urgent Care facility or hospital. Call and ahead to the facility and let them know you are sending an employee for medical treatment. The facility will want to know some basic information, so you at least need to be able to provide their full name, date of birth, and nature of the injury. Some medical treatment facilities may require an Employer Authorization for Examination or Treatment form. This is a form you send with the employee that outlines specific procedure(s) you wish to have completed at the time of service, for example, you may want the facility to complete a drug and alcohol test on top of the examination.
What happens next??? This is where worker’s compensation insurance comes into play. For this article, we are working with the State of North Carolina. If you have 3 or more employees in the state of NC, you are required to have worker’s compensation insurance (there are some limited disqualifying business circumstances, but this is the general statute for NC and each state is different. Be sure to check your states requirements). Carrying this type of insurance will help your employees get the necessary medical attention for work-related injuries, accidents, or illnesses, and can also protect your company from lawsuits by injured workers.
You’ll want to file the worker’s compensation claim as soon as possible, preferably within the first 24 hours from the time of injury or notification of injury. Request the employee’s supervisor to complete an Accident/Injury Report. This report will help provide the necessary details to your worker’s compensation carrier. This report should include details such as time, date and location of the injury, the nature and cause of the injury (fall, strain, sprain, bruise, laceration, etc.), part(s) of the body affected, how the injury was sustained (lifting, bending, running a machine, etc.), as well as any witness information or written statements.
The completed report is then submitted to the worker’s compensation carrier to generate the claim. Be sure to include with the Accident report any and all medical documentation provided by the treatment facility. Ensure they offer a secure process of emailing or faxing any information to them.
If for any reason you are questioning the validity of the employee’s injury or illness, you must let your worker’s comp carrier know when you are submitting the initial claim. During the claim intake, they will even ask if you are questioning the validity of the claim. Depending on the specific circumstances, the claim may be denied by the North Carolina Industrial Commission.
An employee is expected to return to work on the date of injury unless the initial medical provider states the employee must go home for the rest of the day. If the employee’s compensable injury results in lost time from work other than the date of injury, the employee will be put on workers’ compensation leave and is entitled to receive weekly benefits. There is a seven-day waiting period where no compensation for time lost from work is allowed except when the injury results in the inability to work for more than 21 days. If the employee is unable to work for more than 21 days, then weekly compensation is allowed for the first seven days.
If your employee has been given restrictions – it needs to be communicated to their supervisor. You’ll also need to collaborate with HR, and to see whether or not the work restrictions, or modified duty can be met. If you are unable to meet the necessary accommodations, check in with your worker’s comp claims adjuster. They may be able to coordinate a short-term “transitional duty” work assignment. A Transitional Duty Program provides short-term work assignments for employees who have temporary medical restrictions that cannot be accommodated by their employer. It is a structured return-to-work program that provides meaningful and productive work at local non-profit organizations. Your carrier will notify the injured employee of the transitional job offer, and the tasks will be within the physical restrictions as outlined by the treating physician.
Getting an injured employee back to work can help expedite their recovery and return to full duty. In addition, the employee remains productively employed.
The next step is to ensure your worker’s compensation carrier completes the Form 19: “Employer’s Report of Employee’s Injury” and submits it to the North Carolina Industrial Commission. This form MUST be transmitted to the Industrial Commission through your insurance carrier and must be filed within 5 days of learning of the injury or allegation of injury. A copy of the Form 19, along with a blank Form 18, must be given to the employee – again this is something handled by your worker’s compensation carrier – but you should still ensure it is being completed on their end.
A couple of other key notes:
Remind your injured employee that any bills they may receive related to the injury, whether from an urgent care facility, hospital, physical therapist, etc. is not their financial responsibility. Have them give any bills to HR to be forwarded to the worker’s compensation carrier for processing.
When it comes to worker’s compensation in North Carolina, employees cannot direct their own care. The employer or its insurance company, subject to any Industrial Commission orders, provides and directs medical treatment. The employee may petition the Industrial Commission to change physicians or approve a physician of employee’s selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered. Outside of NC, other guidelines may apply so be sure to check those requirements as soon as possible.
If employees travel 20 miles or more round trip for medical treatment in workers’ compensation cases, they are entitled to collect mileage at the rate of 65.5 cents per mile for travel as of January 1, 2023. While it is the Worker’s Compensation Carrier’s responsibility to notify them, it doesn’t hurt to make sure the employee knows.
Most importantly, keep the lines of communication open. Showing you have a vested interest in the safety and wellbeing of your employees, including their rehabilitation in getting back to work, will leave you with more satisfied employees.
Worker’s compensation may not be one of more the glamorous facets when it comes to your business, but it is a necessity. The safety of your employees is critical not only to the success of your business, but at the end of each day, you want to be able to send your employees home safely to their loved ones.
*Disclaimer: When not expressly noted, this article references North Carolina Worker’s Compensation statutes. If you have employees who work in other states, we highly recommend that you research the requirements for those specific states. If you are unsure of where to start, there is an interactive map available on the Department of Labor’s Office of Worker’s Compensation Programs. This interactive map provides the website and contact information for each state.
