Overview: If an employee notifies the employer of a workplace injury, incident or suspected illness, HR must correspond with the employer's workers' compensation insurance carrier (if any) to ensure the carrier is promptly notified. In most cases, notification to the carrier also requires substantial information regarding the incident, the injured or ill employee's job description and classification, a detailed description of the circumstances and the identities of witnesses.
The employer may also wish to perform an internal investigation regarding the circumstances leading up to and including the incident once it has satisfied the carrier's notification requirements. Depending on the results of the investigation, the employer may dispute the validity of the claim by offering one or more defenses including that: (i) the employee was an independent contractor (not truly an employee whose work is controlled and overseen by the employer); (ii) the "going and coming" rule (the employee was injured during his or her commute, for example); (iii) the injuries were the result of intentional conduct; (iv) the employee was intoxicated or (v) the injuries were pre-existing. The validity of each of these defenses turns - in large part - on state law considerations.
Trends: The trend in this area of the law is to reduce the number of injuries and illnesses that are considered "compensable" under the system, while also streamlining the claims process to reduce its impact on state court systems. Despite this trend, the employer still has an obligation to fully and accurately retain documentation on all actions from the moment it is notified of a potential claim to the moment the employee returns to work or is terminated from employment. Accurate, factual and fair records are always the employer's best defense against exposure from workers' compensation claims.
Author: Michael Jacobson, JD, Legal Editor
Enhanced to improve the scope of coverage regarding billing disputes over responsibility for medical treatments, lien filing fees and lien filing process.
Updated to reflect forthcoming amendments to regulations concerning an employer's ability to discourage drug use and employee eligibility for benefits based on marijuana usage.
Updated to reflect a new regulation that clarifies the deadline for requesting a hearing to contest workers' compensation benefits, effective July 1, 2016.
Enhanced to improve the comprehensiveness, organization and scope of coverage and updated to reflect forthcoming requirements for employers to electronically report injury and illness data to OSHA.
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Updated to include information on the 1st Circuit ruling Schwann v. FedEx, which preempts application of the second prong of the ABC Test to motor carriers.
Updated with new 2016 requirement to report employee income tax withheld on quarterly Form 132.
Updated to reflect amendments to workers' compensation regulations governing administration, electronic billing and electronic payments, effective January 1, 2016.