WORKERS COMPENSATION WHAT IS IT?
WHAT IS WORKERS COMPENSATION? Workers compensation laws provide money and medical benefits to an employee who has an injury as a result of an accident, injury or occupational disease on-the-job. Workers Compensation is designed to protect workers and their dependents against the hardships from injury or death arising out of the work environment. It is intended to benefit the employee and employer alike. The employee receives money (usually on a weekly or biweekly basis) and medical benefits in exchange for forfeiting the common law right to sue the employer. The employer benefits by receiving immunity from court actions against them by the employee in exchange for accepting liability that is limited and determined. The question of negligence or fault is usually not at issue.
WHO PAYS FOR WORKERS COMPENSATION BENEFITS? • Employers are required to obtain coverage. North Dakota Law, with limited exceptions, requires all employers to secure workers compensation insurance to cover their full-time, part-time, seasonal, or occasional employees prior to hiring. • Under the North Dakota Century Code, workers compensation provides workers with wage-loss and medical benefits for injuries sustained in the course of employment. General liability, health, and accident insurance are not substitutes for workers compensation insurance.
WHERE DOES MY EMPLOYER OBTAIN WORKERS COMPENSATION INSURANCE COVERAGE? • North Dakota Workers Compensation Law, with limited exceptions, requires all employers to insure their full-time, part-time, seasonal, and occasional workers. • Workers compensation insurance coverage is provided for nearly 300,000 employees across the state of North Dakota. Despite safety efforts and training, nearly 20,000 of those employees are injured on the job each year. • Workforce Safety & Insurance (WSI) manages and regulates an exclusive employer-financed, no-fault insurance system covering workplace injuries, illnesses, and death. WSI is the sole provider and administrator of the workers compensation system in North Dakota.
ARE ALL ON-THE-JOB INJURIES COVERED BY WORKERS COMPENSATION? • Workers compensation covers most, but not all, on-the job injuries. The workers compensation system is designed to provide benefits to injured workers, even if an injury is caused by the employer’s or employee’s carelessness. But there are limits. Generally, injuries that happen because an employee is intoxicated or using illegal drugs are not covered by workers compensation. Benefits may also be denied in situations involving: • Self inflicted injuries (including those caused by a person who starts a fight), • Injuries suffered while a worker was committing a serious crime, • Injuries suffered while an employee was not on the job, and • Injuries suffered when an employee’s conduct violated company policy.
DOES WORKERS COMPENSATION COVER ONLY INJURIES OR DOES IT ALSO COVER LONG-TERM PROBLEMS AND ILLNESSES? • Your injury need not be caused by an accident—such as a fall from a ladder– to be covered by workers compensation. Many workers receive compensation for injuries that are caused by overuse or misuse over a long period of time—for example, repetitive stress injuries such as carpal tunnel syndrome or back and neck problems. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions –for example hearing loss, heart conditions, and lung disease.
DO I HAVE TO BE INJURED AT MY WORKPLACE TO BE COVERED BY WORKERS COMPENSATION? NO • As long as the injury is job-related, it’s covered. For example, you will be covered if you are injured while traveling on business, or even doing a work-related errand.
WHAT TYPES OF BENEFITS WILL I RECEIVE? • Medical benefits • Wage replacement benefits • Permanent Partial Impairment (PPI) benefits • Vocational Rehabilitation benefits. • Death benefits
Can I be treated by my own doctor, and if not, can I trust a doctor provided by my employer? • If your employer participates in the Risk Management Program and has a designated medical provider to care for employees, you are required to see that provider for medical care unless you inform your employer, in writing, of your selection of a different medical provider before any injury occurs. If you do not see your employer's designated medical provider or the different medical provider you selected before an injury occurs, and you choose a different medical provider at the time of your injury, it may result in nonpayment of medical benefits and/or claim denial and you will be liable for the medical costs. • If your employer does not have a designated medical provider in place, you may seek treatment from the medical provider of your choice.
What if my employer tells me not to file a workers compensation claim or threatens to fire me if I do? • You have the right to file a claim for a work-related injury. It is against the law for your employer to harass, discharge, refuse to hire, or, in any instance, discriminate against you for exercising your rights under the Workers Compensation or Occupational Diseases Acts. You may report this type of conduct by an employer to the North Dakota Department of Labor (www.state.nd.us/labor) for their review.
IS MY CLAIM INFORMATION CONFIDENTIAL? • Most information contained in a claim file is confidential and is not open to the public. Information that is available to the public (upon request) is your name; date of birth; injury date; employer name (at the time of injury); type of injury (the body part injured); whether the claim is accepted, denied, or pending (claim status); and whether the claim is in active or inactive pay status. WSI may provide information to doctors and other health care providers who are treating you or advising WSI; vocational rehabilitation consultants; managed care representatives; and your employer at the time of your injury. Additionally, you can grant file access to anyone you wish.
YOUR ROLE IN THE WORKERS COMPENSATION PROCESS
What do I do if I am injured on the job? • Report your injury, no matter how minor it appears, to your supervisor as soon as possible but no later than the start of the next shift.
WHAT SHOULD BE REPORTED? • Allincidents and accidents involving employees, no matter how insignificant they seem. • This documents relative facts. • Provides a loss control tool.
How do I report an injury not requiring medical treatment? For injuries NOT requiring Medical Treatment (minor injuries that require only first aid), the Employee needs to: • Notify your agency Workers Compensation Contact; • Assist the Contact in completion of an on-line incident report to be filed with Risk Management; • Completing and filing this form with Risk Management serves as a record of notification to your employer in the event you require medical treatment in the future (up to one year). • An on-line incident reportshould be submitted to Risk Management within 24 hours of receiving the report of injury.
What do I do if my injury requires medical treatment? For injuries that do require Medical Treatment, the Employee needs to: • Notify your agency Workers Compensation Contact; • Assist the Contact in completion of an on-line incident report to file with Risk Management; • Complete (SFN 2828) and file it with Workforce Safety & Insurance; • Obtain initial treatment from the pre-selected designated medical provider; • Have care provider complete C-3; • Return C-3 to supervisor or Workers Compensation Contact as soon as possible, but no longer than 24 hours after treatment.
What does my employer do if my injury requires medical treatment? For injuries that do require Medical Treatment, the Employee’sSupervisor/Workers Compensation Contact needs to: Complete First Report of Injury Form (FROI) and file it with Workforce Safety & Insurance (WSI) within 24 hours after learning of the injury. • Traumatic Injuries require the Supervisor to immediately file the FROI and notify Risk Management by phone (328-7583), fax (328- 7585). or email (email@example.com). • Employee must complete Section 1 and 2 of the FROI form as soon and as possible, if possible, with the supervisor/Workers Compensation Contact.
What can I expect after I filed a claim? • You will be contacted by a Claims Adjuster from Workforce Safety & Insurance (WSI) and, if the claim results in lost work time, you will be contacted by a Nurse Case Manager. • These professionals will assist you with your claim and help answer any questions that you may have. • You will also receive a letter in the mail from WSI notifying you that your claim has been accepted or denied. • If your claim is denied the letter will also explain what steps you can take to have your claim reviewed. • AT ALL TIMES YOU ARE REQUIRED TO FOLLOW THE REQUIREMENTS SET FORTH BY YOUR MEDICAL PROVIDER AND WSI.