Managing claims Q&A: Answers to some of our most common claims questions

We asked our claims representatives what questions they typically hear from employers who are managing employees with workers’ compensation claims. Here are a few common questions, and the answers:

How do we manage performance issues when an employee has an active workers’ compensation claim?

When an injured employee isn’t performing the duties of their job up to your standards, the first thing you need to ask yourself is whether the substandard performance is related to the work injury.

If it is related, you may need to review the tasks assigned and confirm they fall within the employee’s medical restrictions. Your claims representative and rehab professional (if one is working with the employee) can assist with this process.

If it is unrelated to the injury, the next thing you need to ask yourself is how other employees are treated when similar performance issues arise. All employees should be treated the same, including the injured employee.

After you’ve decided what you’re going to do, act promptly because your silence implies approval and condones the performance. If the performance concerns are not addressed right away, but you later bring up the issue as a reason for discipline or termination, the employee could claim the issue is simply a “pretext” and that the real reason for the discipline is the work injury. Employees cannot be disciplined for suffering a work injury.

Lastly, be sure that you thoroughly document any performance concerns and disciplinary action. If you do feel you need to terminate an employee who has suffered a work injury, we’d recommend discussing it with your claims representative and your employment law attorney. They can walk you through the potential workers’ compensation implications of terminating, and whether there may be a basis for an employment law claim.

How do we handle the employee’s health insurance premiums while they are off work due to a work injury?

This differs by state. For example, in Minnesota, the law prohibits terminating group insurance for an employee who is absent due to becoming totally disabled.

Talk with your employment law attorney to make sure you’re aware of any relevant laws and rules. Workers’ compensation wage loss benefits do not include health insurance premium withholding.

How do we maintain a good relationship with an employee who is off work due to a work injury?

The most important thing you can do after an injury is to stay in regular contact with the injured employee. Call or text the employee right away, and keep in touch.

First and foremost, let the employee know you care about them and want to see them recover. Send a card or small “get well” gift if appropriate.

Another thing you can do is to make sure the employee knows that you will provide any needed accommodations so that they can return to work as soon as they’ve healed enough to come back. Injured employees who are off work often worry that they won’t have a job to return to, and this will help alleviate those concerns.

If you ever have a question about managing a claim, don’t hesitate to reach out to your SFM claims representative for help.

 

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

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