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- Workers’ Compensation Claims for Health Care Workers

Health care workers face many health risks and situations that can lead to injuries in their daily work.
This is why it’s so important that they understand what types of benefits they may be entitled to, as well as the eligibility process for obtaining them. Below, we’ll explore the details of workers’ compensation claims for health care workers specifically.
It’s important to note that workers’ compensation benefits can vary significantly depending on the jurisdiction, which is why you’ll want to make contact with your state’s workers’ compensation board to confirm eligibility requirements, benefits offered, and details about the claims filing process, including documentation required to apply for workers’ comp.
Understanding Workers’ Compensation
The workers’ compensation system provides benefits to employees who suffer work-related injuries or illnesses, typically covering medical expenses, lost wages, and rehabilitation costs.
For health care workers, this means they can get much-needed financial support if they’re injured in the performance of their job duties (such as lifting patients, handling hazardous materials, or being exposed to infectious diseases.)
Common Injuries and Illnesses Among Health Care Workers
The Bureau of Labor Statistics reports that health care workers suffer more injuries and illnesses than any other industry. This includes construction and manufacturing. Specific health care jobs like those employed in nursing and residential care roles face the most significant risk.
Some common injuries or illnesses those individuals employed in the health care industry face include:
- Musculoskeletal Issues: Lifting and moving patients from beds or wheelchairs can result in a variety of musculoskeletal injuries. Musculoskeletal injuries can affect the worker’s back, shoulders, and neck, causing debilitating, chronic pain and necessitating long-term treatment and rehabilitation.
- Needlestick Injuries: These are a common danger among health care workers and can lead to potential exposure to bloodborne pathogens like HIV or hepatitis. It’s crucial to receive an immediate medical assessment and treatment in these cases.
- Proximity to Illness: Health care workers, especially doctors and nurses, run the risk of contracting an infectious disease every day, given their constant exposure to patients. Diseases like tuberculosis, influenza, and COVID-19 are a constant concern for them.
- Slips, Trips, and Falls: The often frenetic pace of a health care facility makes slips, trips, and falls a frequent issue. Wet floors, cluttered or crowded hallways, and rushed movements all add to the likelihood of these accidents, resulting in injuries like fractures, sprains, and head trauma. The U.S. Department of Labor (DOL) reports that, in 2021-22, 26,000 slip and fall accidents in the health care industry required these employees to miss days away from work or restricted their activities.
Eligibility for Workers’ Compensation
For health care workers to qualify for workers’ compensation, they must meet specific criteria, including proving that their injury or illness is work-related and occurred while performing their job duties.
Doing so will mean providing medical documentation and sometimes witness statements to support their claim.
Other eligibility requirements include:
- Employee Status: You must be an employee to be eligible for workers’ compensation benefits. Independent contractors or volunteers do not usually qualify for coverage. As a health care worker, you should verify your employment status in advance to determine your eligibility for workers’ comp benefits.
- Reporting the Injury: Reporting your injury promptly is crucial. You must inform your employer of your injury immediately after it occurs or as soon as you become aware of a work-related illness. Any delays in reporting can lead to difficulties in the claims process which can result in a denial of your workers’ comp benefits.
- Medical Treatment: It’s equally important to seek prompt medical treatment, both for your health and for your workers’ compensation claim. You should visit a medical professional that’s been approved by your employer. This documentation of your injury, its severity, and any treatment plan, is vital for supporting your claim.
Filing a Workers’ Compensation Claim
Filing a workers’ compensation claim can be a complex process and can vary depending on your state. In general, you should follow the steps below to help make sure that your claim is processed smoothly.
As mentioned above, your first step is to notify your employer of the injury. This should be in writing and include details about how, when, and where you were injured.
Some states have specific forms that need to be filled out, so you should check your local requirements.
Once you’ve notified your employer, you’ll need to complete a workers’ compensation claim form, providing information about your injury, how it happened, and the medical treatment you’ve received. Be as accurate and thorough as possible when completing this form, as it’s crucial for a successful claim.
Submit the completed form to your employer or workers’ compensation insurance provider. You should keep copies of all of these (and any other) documents for your records.
Once submitted, your employer or insurer will review your claim to determine eligibility.
The insurance company may require a medical exam by an independent doctor of their choice, as well, to verify the extent of your injury and any treatment you may require. It’s important to cooperate with this process because refusing to attend an independent medical examination can result in a denial of your claim.
Once workers’ compensation claims for health care workers are reviewed, insurers will either approve or deny them.
If approved, you’ll be notified and start receiving benefits, which may include medical treatment, wage coverage, and rehabilitation. If your claim is denied, you have the right to appeal the decision through your state’s workers’ compensation board or commission.
Benefits of Workers’ Compensation
Workers’ compensation provides a number of benefits to sick or injured health care workers. The better you understand these benefits, the better you’ll know what to expect and how to use them most effectively.
- Medical Benefits: Workers’ compensation covers all necessary medical treatment needed for your work injury or illness. This can include costs of doctor visits, hospital stays, surgeries, medication, and physical therapy. Make sure that all treatments are documented and related to the work injury to avoid coverage disputes.
- Wage Replacement: You may also be eligible for wage replacement benefits. These benefits cover your lost wages while you’re in recovery. Typically, you’ll receive a percentage of your average weekly wage to help with your financial needs while you’re unable to work.
- Disability Benefits: If your injury ends up causing a temporary or permanent disability, you’ll be eligible for various types of disability benefits. These will vary depending on the severity of the disability and how it’s impacted your ability to perform your job. Temporary disability benefits are available if you’re expected to fully recover, while permanent disability benefits cover any lasting impairments.
- Vocational Rehabilitation: Workers’ compensation often includes vocational rehabilitation opportunities. These are to help you return to work by providing job training, education, and job placement help if you can’t return to your previous job or perform the same duties. For health care workers, this may mean moving into a less physically demanding role in the health care field or finding something completely new.
- Death Benefits: In 2022, there were around 5,500 worker fatalities reported in the United States, also per the DOL. In the unfortunate event of a work-related fatality, workers’ compensation can provide death benefits to your dependents. These typically cover funeral-related expenses and financial support for your family.
Challenges in Workers’ Compensation Claims
Filing a workers’ compensation claim can pose some challenges. You should be aware of these potential obstacles and be ready to address them:
Claim Denials
Many workers’ compensation claims are initially denied.
Insurers may deny first-time claims for a wide variety of reasons, often things like insufficient evidence, missed deadlines, or questions over the work-relatedness of an injury. You can appeal denied claims by providing additional information or by seeking legal help.
According to the Social Security Administration, 67% of claims that are originally denied are converted to paid claims within one year.
Delays in Benefits
Delays in receiving your benefits can cause serious financial strain. These can result from departmental backlogs, disputes over claim details, or delays with receiving medical documentation.
It’s important to stay in contact with your employer and/or insurer and quickly respond to any requests for additional information to help minimize delays.
Navigating the Legal System
Like most legal situations, navigating the laws, regulations, and requirements of the workers’ compensation system can be complex and sometimes frustrating. Consulting with an attorney who specializes in workers’ compensation can greatly assist with the claims process, while also helping to ensure that your rights are being protected.
Workers’ compensation is a vital asset for health care workers who suffer injuries or illnesses on the job.
Understanding the process of workers’ compensation claims for health care workers, your state’s eligibility requirements and your potential benefits can help you navigate the system effectively.
By following these steps and getting professional help to deal with potential challenges, health care workers can secure the benefits they need to recover and continue their important work.