Understanding Work Related Injuries

Understanding Work-Related Injuries

HCR/230

February 5, 2012

Sharlene Batts

Worker’s compensation is an insurance plan developed to provide workers benefits that cover expenses such as medical bills and lost wages after being injured on, or getting an occupational disease or illness as a result of, the job. Worker’s compensation insurance, just as any other type of insurance, has certain procedures for processing claims to receive benefits. This paper will give a description for the procedure used to process claims for worker’s compensation insurance. It will also explain the responsibilities of each of the involved parties; how the HIPPA Privacy Laws apply, and the implications of those laws.

Processing claims for worker’s compensation begins with the employee reporting the injury as soon as it occurs, or as soon as it discovered, to the employer. The employer, in turn, reports the injury to the worker’s compensation office and the insurance carrier (Valerius, Bayes, Newby, & Seggern, 2008). Reporting these injuries to the employer, worker’s compensation office, and the insurance carrier has a time limit to do so, although it may not be the same in each state. Once the injury has been reported, the injured employee must be examined and treated by a physician that has been approved to do so. This physician does an initial report that is either sent directly to the insurance company, or sent to the employer who then sends it to the insurance company to be processed. After the initial report is processed and, if accepted, the payment is sent directly to the physician (Valerius, et.al, 2008). If the claim is not accepted, appeals may be made beginning with requesting a mediator. If this fails to resolve the issue, a hearing may be requesting, in which case the judge makes the decision. However, the judge’s decision may also be appealed at an appeals board for worker’s compensation or a state supreme court.

Each party involved (the employee, employer,...