Workers Compensation Explained – Why You Need Experienced Attorneys

utilization review (UR)

As Insurance Business explains, workers’ compensation is insurance that pays for medical care and part of an injured employee’s lost wages. It’s also a common law requirement for businesses.

It would help if you communicated clearly and consistently with employees about how workers’ comp works. That includes establishing the policy in the handbook, conveying it to new hires as part of orientation, and communicating it regularly during safety reviews.


The injury or illness must be reported when an employee is hurt or ill due to a workplace-related accident. Usually, legal representation like the worker’s compensation attorneys at is needed to help ensure that a worker’s compensation claim is filed and processed correctly.

Workers’ compensation systems were designed to provide partial medical care and income protection for employees who are injured or become ill in the course and scope of their work. Most employers buy workers’ compensation insurance through private insurers or participate in state-certified workers’ comp insurance funds or self-insurance pools.

Executive officers and directors of quasi-public or private corporations may exclude themselves from coverage by executing a waiver. However, they must be covered if they are rendered services for pay while on company property or in a vehicle owned or operated by the employer. Often, disputes arise about the existence, duration, or extent of disability. These disputes can be resolved through precertification authorization or a contested case hearing.


If your business is legally required to carry workers’ comp or you choose to maintain coverage voluntarily, it’s important to understand how this policy works. With such understanding, your company could avoid legal liability if an employee files a claim.

A workers’ compensation policy covers the cost of medical care and a portion of lost income for employees injured or ill due to their jobs. The rules and benefits vary by jurisdiction.

In many states, treating physicians send treatment requests to the insurance carrier for utilization review (UR). These UR decisions can allow or modify treatment or even decline treatment completely.

Disputes can arise around whether an injury is work-related, whether it meets the criteria for disability or the existence, duration, or extent of the injury. There are disputes over how much an injured worker is entitled to receive. These issues can significantly impact your company’s time and money on a particular case.


Workers’ compensation is a system of benefits that pays for medical care and partial income protection for employees who are injured or become ill “in the course and scope” of their work. Most states mandate it. It also typically gives an employee a limited right to sue a third party for negligence that contributed to the injury.

A business owner needs an agent familiar with the state laws and regulations governing workers’ comp. In addition, the best agents can offer tools and resources that help clients reduce risks, such as access to safety consultants, training on loss control programs, return-to-work plans, and more.

In addition, a good agent will be able to explain to employees how the workers’ comp process works and answer any questions they may have. This can go a long way toward building trust with employees and helping them feel valued.

Alternative Dispute Resolution

A workers’ compensation policy covers the cost of medical care and partial lost income for your employees if they get hurt or sick on the job. It also protects your company from being sued by your injured employees.

In exchange for these benefits, your employees give up their right to sue you for any injury they suffer. However, they can still sue any third parties that may have contributed to the injury.

Most states require employers to buy a workers’ comp insurance policy. Mutual and stock insurance companies compete to write this type of coverage. However, some states allow large, financially stable companies to self-insure their workers’ compensation exposure if they meet rigorous qualification standards.

Workers’ comp benefits are not based on fault but rather on the severity of the injury. It can pay for your injured employee’s medical treatment, including hospitalizations, surgery, physical restoration, and physical therapy. It also pays for prescriptions, x-rays, and lab services.

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