Everything You Need to Know – Workers Compensation

We know. You’re probably thinking “Ah, jeez… not this again.” And we get it. At first glance, Workers Compensation may be seen as an intimidating and complex process to understand. But, hear us out… whether this is your grassroots experience learning about Workers Compensation or you’re a seasoned Insurer looking for a quick refresh, our goal is simply to break down its key elements, and supply you with the knowledge needed to deal with such proceedings confidently.

When it comes to Workers Compensation, a no-fault system exists, meaning that an injured worker receives treatment and benefits despite who is at fault, even if it’s the worker. You may also hear it referred to as “The Grand Bargain” because it relies on an assumption that an accident did indeed occur, and that the Employee is entitled to compensation, unlessthe Employer and Insurance Carrier manage to prove otherwise.

There are other rebuttable presumptions when an accident occurs such as:

• A compensable accident occurred
• Timely notice was given
• The injured worker was not trying to intentionally self-harm
• It was not caused solely by intoxication
• The medical reports constitute PFME

The top 3 parts to WC are: lost wages, medical expenses paid, and loss of use of body part(s). The one which usually holds the most contention in civil court is the latter of the 3 – loss of use of body part(s). The 2 most critical elements of every WC Case are Accident Notice Casual-Relationship (ANCR) and Average Weekly Wage (AWW). ANCR means the injuries or conditions, which can range all the way from Post-Traumatic Stress Disorder to a right eye injury. And the AWW is the average weekly earnings over the past year. It’s based on multiple factors, such as C-240 Payroll, Tax Returns, and Testimony, and is a very important measurement tool because it’s used in calculating all other values.