Risk & Business Magazine Bowen Miclette & Britt Fall 2016 | Page 26

WORKERS’ COMPENSATION

BY: JEFF CRENSHAW, CRIS, CLCS,
DIRECTOR OF SPECIAL PROJECTS
AND CLIENT ADVOCATE, AT
BOWEN, MICLETTE & BRITT

Workers’ Compensation
Are You Covered?

I

f you remember in my first workers’
compensation article, I mentioned a
saying that I learned in an insurance
school I attended: “Workers’ comp is
meant to be the sole, exclusive remedy
for work-related injuries.” In this article, we
are going to discuss what workers’ comp
covers. We are going to focus on the great
state of Texas for simplicity’s sake, as every
state is different and will have different laws
that govern its workers’ comp laws. My main
source for this information is the Texas
Department of Insurance (TDI). It has a lot
of great information on its website regarding
workers’ compensation insurance.
TDI DEFINITION OF WORKERS’ COMP
Workers’ compensation is a stateregulated insurance program that helps
people with work-related injuries and
illnesses. Employees covered by workers’
compensation get medical care necessary to
treat their injuries and illnesses. Depending
on the type and severity of the injury,
workers’ compensation may also provide:
•

Payments to replace some of an injured
employee’s lost income, up to time and
dollar limits set by law;

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•

Compensation for burial expenses for
employees killed on the job; and

•

Death benefits for dependents of
employees killed on the job.

Workers’ compensation doesn’t pay for
injuries that:
•

Are intentional or self-inflicted;

•

Result from horseplay or voluntary drug
or alcohol intoxication;

•

Are inflicted by someone for personal
reasons unrelated to the job;

•

Result from voluntary participation in
off-duty recreational, social or sports
events; or

•

Result from “acts of God” (like floods
or hurricanes), unless the job has a high
risk of injuries from such causes.

After September 11, 2001, terrorism
insurance became mandatory on all
Workers’ Comp policies.
Most of your workers’ comp carriers have
set up provider networks just like a health
insurance carrier does. These networks are
designed around medical staff and doctors
that specialize in injured employees. You

will usually receive a discount (and often
a fairly substantial discount) if you agree,
when you are signing up for the policy, that
you will only use that carrier’s “in network”
providers. You do not have to choose this
option as you can send your employee
wherever it is most convenient for you, but
then you would not qualify for the discount.
It is a great idea to find out how expansive
the network is before you choose a workers’
comp carrier. Also, be careful when you send
your employee to a workers’ comp doctor.
There are times when a facility sees that an
injury is workers’ comp related, and your
employee quickly becomes more of a dollar
sign to the facility rather than a person.
The medical portion of your workers’
comp policy is a lifetime indemnity benefit
in certain situations, but the majority of
workers’ comp claims do not rise to this
level. +

Jeff Crenshaw, CLCS, CRIS is Director of
Special Projects and Client Advocacy, and
has over 15 years experience in Insurance
and Risk Management.