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
Updated to reflect a court decision regarding the independent contractor test under California's wage orders.
Updated to reflect amendments regarding reciprocity of employee coverage, effective July 1, 2018.
Updated to reflect US Department of Labor (DOL) regulations concerning the Longshore and Harbor Workers' Compensation Act (LHWCA).
Updated to reflect an amendment regarding claims involving mental impairment, effective July 1, 2018.
Updated to include the requirement that all employers must file quarterly reports and payments electronically, effective January 1, 2018
Updated to reflect information on an Oklahoma Supreme Court ruling regarding independent medical examinations.
Updated to reflect an amendment to the coverage exemptions, effective August 1, 2017.