What the heck is Workman's Compensation?
Many of us are confused by all of the lingo and classifications when talking about employment issues. One of the major goals of Pro Equine Grooms is to turn something that is "clear as mud" into "clear as glass" in regards to employment in the horse industry. So, as we enter the big world of Workman's Compensation Insurance, let's be super clear as glass on two critically important things.
-Workman's compensation is required by law for EMPLOYEES, not independent contractors. It is mandatory for EMPLOYERS to provide it for employees. This is why it's so critical that your boss classify you correctly as an employee, and not independent contractor. Read this work of art about "Employee vs. Independent Contractor" here to learn more about the differences. Very few Grooms are actually independent contractors.
-Workman's compensation is NOT the same as heath insurance. Employers are not required to offer health insurance as a benefit to employment.
WHAT IS WORKER’S COMPENSATION INSURANCE?
A Barn Foreman is involved in a truck accident on the way to purchase feed from a local feed store, but can return to work the next day. An experienced Dressage Trainer is thrown from a horse and breaks her arm while practicing for a high stakes competition, and can't work at full capacity until the cast is removed. A Groom is kicked in the knee while cleaning the sore hoof of a horse with laminitis and needs a week away from work to recover. A Stablehand falls from a ladder while repairing a barn roof and sustains major back and neck injuries, never being able to work again.
The people in these scenarios may have huge medical bills. Who do you think should pay the bills? Who is at fault for the injuries? Do you think any should be eligible for Worker’s Compensation benefits? (the answers to these questions can be found in the article!)
What Really Is Worker’s Compensation Insurance?
Employees who are injured, become ill or die in the course of their daily work activities are most often covered under Worker’s Compensation insurance. Workman's Compensation is required by law for employers to have to protect their employees! Workman's Compensation provides benefits for employees injured on the job. Workman's Compensation laws require employers to give cash benefits, which are paid by the policy on behalf ot the employer, to replace lost income, medical care and rehabilitation services for injuries or illnesses employees sustain as a result of doing a job or performing their work. The employer is responsible to the worker for job-related injuries and injuries related to the safe entering and exiting of a job site.
Employees are entitled to quick and certain payment from the Worker’s Compensation system without proving the employer is at fault. In exchange, employees may give up the right to legal awards provided the injury was not the result of gross negligence by the employer. And the employer enjoys limited liability for occupational illness or injury from the employee, but not from citations or fines from government agencies such as OSHA (Occupational Safety & Health Administration). Worker’s Compensation is a no fault insurance: benefits are usually paid to an injured worker no matter who is at fault. However, in exchange for receiving benefits, employees often give up the right to sue their employer for damages resulting from work-related injuries.
How Do Employers Provide Workman's Compensation coverage?
Employers purchase insurance from a private carrier either directly or through an insurance broker, or from a state insurance fund. Employers pay a percentage of an employee’s wages to the insurance company determined by the job classification of each employee. Ex: an employer will pay more in Workman's Compensation insurance for a barn manager working around horses and using farm equipment than for the office manager. Bills are paid monthly and depending on the number of employees in high injury risk jobs, can run into the thousands and up into the millions of dollars per year. Workman's Compensation insurance protects injured workers, while preventing the employer from having to pay the employee's medical expenses out of pocket.
Employers may also be self-insured meaning the employer covers most or all of its insurance risks, yet an insurance company will manage the claims process. An employer chooses to cover any medical expenses to employees resulting from an on-the-job injury instead of purchasing and paying premiums for worker's compensation insurance.
All states require employers carry some form of Worker’s Compensation insurance. Texas and New Jersey do not require employers to purchase W/C insurance.
What Will My Employer’s Workman's Compensation Cover?
If an employee experiences an injury, illness or death on the job, then Worker’s Compensation most often applies. Employees must report a job-related injury or illness preferably using the employer’s injury reporting procedures including completion of any required forms. The employer might then alert the insurance carrier and files a claim on behalf of the employee. Benefits awarded to an injured worker include wage replacement up to 2/3 of reported and earned salary, reimbursement for medical expenses, doctor bills, hospital stays and rehabilitation costs related to the injury. ‘Pain and suffering’ are not generally considered a claim under Worker’s Compensation although some states allow benefits for stress-related illnesses. If the employee dies, state laws determine the amount of compensation awarded to a surviving spouse or dependents such as the employee’s children.
Workers' Compensation might cover:
Injuries on-the job including the loss of limbs
Occupational illnesses such as emphysema from asbestos exposure
Stress-related health issues
Rehabilitation needed so workers can return to work
Lost wages (up to two-thirds of the employee's salary)
Repeated ‘trauma’ such as repetitive strain injuries
Who Qualifies for Benefits?
All regular employees who are injured while performing work in the course of his/her job and are paid from the regular payroll including full time, part-time, and temporary employees may qualify for benefits. Independent contractors, consultants, agency temporary employees, and any workers paid from an invoice and issued a year-end 1099 may not be eligible for benefits. However, non-regular employees may file a claim; the insurance company and the state Worker’s Compensation Board will determine any eligibility for benefits.
Time Limits for Reporting and Filing A Claim
There are time limits to filing a claim to be eligible to receive Worker’s Compensation benefits which vary from state to state. Average time limits are between 30 and 90 days. In some states, the time limit is longer. In California, the time to file is between one to five years. There are exceptions to filing limits that apply in most states: if the injury results in a coma, or the injury requires prolonged medical treatment, a severe injury that prevents the employee from filing within the time limit.
In most states, an employee has thirty (30) days or less to report claim to an employer. A general rule to follow if you are injured on the job is to report the injury and file a claim as soon as possible.
Your employer may not fire you for filing a Worker’s Compensation claim, nor retaliate against you in any way.
Follow These Simple Steps
1. Notify your employer immediately or as soon after your injury as possible.
2. See a doctor. Check with your employer for a referral, approved clinic, healthcare practitioner or ask if you are able to seek treatment from a doctor of your choice.
3. Fill out all the forms given to you by your employer and be sure to describe the nature and extent of your injury. Be prepared to provide a detailed account of how, where and when your injury happened and if there were any witnesses.
4. Keep all appointments related to your injury.
5. Follow recommended treatment plans, and if you have concerns, notify your employer.
Remember, Worker’s Compensation Is NOT Health Insurance!
If you catch a cold from your co-worker, or contract the flu from a riding student, you are not eligible for benefits under Worker’s Compensation.
In a nutshell - here are the major point to know when comparing Workman's Compensation Insurance to Health Insurance:
Workman's Compensation is:
Required by law
Paid by employer
Covers lost wages, med expenses, and rehabilitation due to workplace injury
You can’t sue your employer for negligence
Each state has own laws and programs
Required in all states (conditional in TX and NJ)
What is health insurance?
Covers parts of med expenses for preventive medicine, routine, emergent care and prescriptions
Helps with accidents outside of the workplace
Optional benefit provided by employers - not required by law to be provided by your employer
Can be obtained by joining a group, association, or and insurance pool under the new healthcare reform law.
Once again, we have Marcia Hancock from www.thejobsearchadvisor. com to thank for this comprehensive article. Please feel free to ask any questions here, Marcia and I are more than happy to help. You can also email us if you prefer some privacy.
Marcia Hancock, The Job Search Advisor
Specializing in writing resumes, biographies, curriculum vitae (CV) and other resume-like documents for self-employed professionals and employees within the horse industry.
Disclaimer: The contents of this article are opinion only and based on the experience of the article's author and not to be construed as legal advice in any respect. Consult an attorney before taking action based on the contents of this article. Marcia Hancock, Liv Gude, and Professional Equine Grooms, LLC. expressly disclaim all liability in respect of any actions taken or not taken based on any contents of this article.