An employer must post the name of its workers’ compensation insurance carrier in a conspicuous place at the workplace. In order to avoid denial of insurance coverage, the employer must also place the workers’ compensation carrier on notice of any work accidents or claims of injury. After notifying the insurance carrier of the accident, the employee should receive a claim number from the carrier, which must be used to obtain medical treatment.
Of course, in the case of an emergency, an employer should call an ambulance or otherwise transport the injured worker to a hospital. If the injury does not require emergent medical care the employer may instruct the employee to make an appointment with a “company doctor,” until the workers’ compensation insurance carrier directs the employee to a specific physician within their network. If the employer does not have a company doctor, then the employer may advise the injured worker to go to his own doctor, until the insurance carrier directs treatment elsewhere. The employer should not instruct the injured worker to use his health insurance to obtain medical treatment– to do so potentially constitutes insurance fraud.
The terms of the workers’ compensation insurance policy require the employer to cooperate in providing investigation regarding the accident, as well as wage information, so that benefits may be paid promptly to the injured employee. The employer should prepare an accident report to document the injury. In addition, employers must file a “First Report of Injury” form, which may be found on the New Jersey Department of Labor’s website.
If there is some question about whether an accident occurred, it is advisable for the employer to investigate the accident by obtaining witness statements and then turning the investigation over to its workers’ compensation insurance carrier. The bottom line is that even if an employer does not believe that an injury occurred, it is incumbent upon the employer to report the accident to the workers’ compensation carrier. The carrier will then continue the investigation started by the employer and will refuse to pay the claim if it is not legitimate.
The employer should provide the carrier with a copy of the accident report, if any, and pass on any statements made by the employee and co-workers regarding complaints of injury before or after the accident. If the accident was a result of negligence by an outside company or individual, the employer should share that information with the claims adjuster.
The carrier will ask the employer to complete a 26-week wage statement, listing the employee’s weekly salary for the 6-month period prior to the accident. Overtime pay must be included in the wage calculation. Unfortunately, it is not uncommon for benefits to be delayed because an employer fails to complete the required forms to the carrier on a timely basis. Injured workers may speed up the process by providing their attorney with a complete copy of their paystubs.
Yes; it is important to remember that the fraud provisions of the Workers’ Compensation Act apply to employers as well as employees. Accordingly, if the employer knowingly reports incorrect information to the workers’ compensation carrier, to deny a legitimate claim, the employer could potentially be charged with a crime in the fourth degree, and subjected to civil penalties and attorneys’ fees.
If an employer has a valid workers’ compensation insurance policy, then the insurance carrier alone will be held responsible for the payment of benefits to the injured worker. However, if an employee is a minor, insurance coverage will only be extended if the employer obtained “working papers” for the minor. If not, the employer could potentially be held directly liable for double benefits to be paid to the underage employee. Accordingly, employers of teenagers must confirm that the appropriate paperwork is kept on file.
The Workers’ Compensation Act does not require employers to accept an injured employee back to the workforce if she is medically unable to perform all of her job duties. However, insurance carriers often encourage employers to offer “light duty” work, in an effort to stop payment of temporary disability benefits. Many businesses financially suffer from such an arrangement, if they are forced to pay a salary to an employee who is unproductive due to injury. An employer may and should stand up to the insurance carrier’s efforts to hoist this cost onto its business. Employers generally pay high premiums to the insurance industry and should not be fooled into putting injured employees back to work prematurely, to the detriment of their businesses and the health of their employees. If the employer refuses to offer light duty work, the injured worker will continue to receive temporary disability benefits from the insurance carrier until she is released to return to work full duty, or is discharged from active medical treatment.
The Workers’ Compensation Act does not prohibit an employer from terminating an employee who is injured during the course of employment. However, it is illegal for an employer to take any adverse employment actions against a worker in retaliation for reporting a work accident or applying for workers’ compensation benefits.
Employers should also keep in mind that other state and federal laws may be implicated in the termination of an injured employee. For example, both the federal Americans with Disabilities Act and the New Jersey Law Against Discrimination require employers to provide “reasonable accommodations” to injured workers, which could include unpaid medical leave time, or to hold a position for an employee who is medically unable to perform the “essential functions” of her job. The safest course of action for employers considering the termination of an injured worker is to consult with an attorney who specializes in employment law.
When the employee is released to return to work by her doctor the insurance carrier will terminate payment of temporary disability benefits, often the same day. Accordingly, employers should allow the injured worker to return to work as soon as possible. The employer should immediately advise the employee if the position is no longer available because it has been filled or eliminated, so that she may apply for unemployment compensation benefits. On the flip side, employers should immediately advise the workers’ compensation carrier of the date when an injured worker returns to work, to avoid the overpayment of temporary disability benefits by the insurance carrier.
For more information on the Responsibilities Of The Employer, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (908) 923-0020 today.