When dealing with small medical bills, you may think that covering it yourself rather than submitting it to your workers’ compensation insurer will be easier and less costly.

While this seems logical, choosing to pay a medical bill yourself can create a ripple effect of future problems.

In many states, unless your business is self-insured, paying a claim rather than reporting it to your workers’ compensation insurer may be illegal. It’s could also be a violation of your contract with your insurer because it can artificially lower your experience modification factor (e-mod) and premium.

Other reasons why an employer may not want to pay might also include:

• It could be held as an admission of liability for an injury or admission of an injury
• In most states, an employee cannot waive the statutory right to work comp benefits

Of course, as is the case with most employment laws, they vary by jurisdiction. Here are a few examples.

Minnesota

The Minnesota Department of Labor and Industry explains why employers should not pay medical bills in its training guide for employers .

“If an employer does not report an injury to its insurance company, it could become a more expensive workers’ compensation claim. The workers’ compensation law is complicated. It has many requirements, such as deadlines for payment, forms that must be filed, determining what medical treatment is reasonable and paying bills according to medical fee schedules. Workers’ compensation insurers are required to know how to comply with these requirements. Penalties may be imposed if the claim is handled inappropriately. If the error leading to a penalty was the fault of the employer, the insurer may pass that cost on to the employer. The employer may jeopardize the ability to adequately defend the claim or opportunities to minimize losses if the insurer does not have immediate knowledge of the injury.”

However, exceptions may be allowed under a large deductible policy or if it is a self-insured person with approval from the state department of commerce to directly manage and pay work comp claims.

Wisconsin

In Wisconsin, employers can pay work comp bills, but there are limited circumstances when they can pay.

There is also an exception for the self-insured in Wisconsin.

South Dakota

It is not illegal to pay such expenses in South Dakota.

And employers should note that if they do not carry work comp coverage they can be sued civilly.

Again, there is an exception for the self-insured.

Iowa

Likewise, Iowa allows employers to pay medical bills. An employer has the right to choose the medical care/medical provider, meaning an employer would have the right to pay.

There are other factors to consider for the self-insured, and criminal and civil penalties could be levied against employers that violate the mandatory insurance law.

Nebraska

In Nebraska, it is illegal for employers to pay medical bills for injured workers.

Exceptions may be made under a large-deductible policy, but it still requires the insurer to pay with reimbursement to the employer or is self-insured with approval by Nebraska courts.

Kansas

Kansas also allows employers to pay these bills.

If an employer is insured for work comp, by law the insurance carrier is responsible for paying.

In the limited circumstances where an employer does not have to carry workers’ compensation insurance, uninsured employers subject to work comp laws are responsible for the medical bills of covered employees. Also, an employer has the right to choose the treating physician.

In Kansas, an employer can be self-insured for workers’ compensation, but must demonstrate to the state the financial ability to pay any claims that might arise.

Missouri

Missouri allows employers to pay medical bills for their workers. But there are additional rules to note.

If an employee misses no time from work and all medical bills total less than $3,700, the employer may pay the bill. However, employers must notify their insurance carrier and the Missouri Division of Workers’ Compensation and is not included in the e-mod.

Tennessee

Lastly, Tennessee also allows employers to pay medical bills out of pocket.

Reasons not to pay out-of-pocket work comp costs

Beyond the legal obligations in many states, there are other reasons  employers should not make out-of-pocket payments for a workers’ compensation injury, including:

• Additional expenses; carriers often have pre-negotiated rates for care
• Should an injury become worse, and it wasn’t reported in a timely manner, a claim could be denied
• Doing so could impact your experience modification factor
• Potential cancellation of a policy

As noted above, it’s generally better to go through the proper channels when taking care of an injured employee.

Originally posted December 2017; updated February 2024.

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

Generally, motor vehicle accidents that occur when employees are traveling to and from the workplace are not covered by workers’ compensation.

However, there are two exceptions:

• If employees are required to bring their cars to the office for use during the workday, then travel to and from the office and business travel during the day are generally covered by workers’ compensation
• If you regularly provide transportation to and from the workplace in company-operated vehicles — such as buses, trucks or vanpools — injuries to employee passengers would be covered by workers’ compensation

Even if you’re unsure whether an automobile accident is covered by workers’ compensation, it’s always best to immediately report it to your work comp insurer.

If an employee is injured in a car crash, who pays medical bills? The auto insurance company or workers’ comp carrier?

If an employee is injured in a work-related car accident, workers’ compensation is the primary source of insurance for medical and wage-loss benefits.

This is why it’s important to report an incident to your workers’ compensation insurer right away if you have an employee who was injured in a work-related car accident.

What should employees do if they get into a car accident while driving for work?

If you have employees who drive for work, ask them to do the following if they are involved in an accident:

1. Call for help

Call an ambulance immediately if anyone is injured.

At the same time, even if there aren’t injuries, have employees call local law enforcement to the scene to file a police report and issue any citations. If this isn’t possible, make a legal accident report with the applicable police department as soon as possible.

2. Obtain key information

Find out:

• Names, addresses and phone numbers of witnesses and everyone in each vehicle
• License numbers and state registrations of all vehicles involved
• Insurance information from the other driver

3. Report it to you (their employer)

Immediately report the accident to the person in the organization who handles workers’ compensation claims.

What if the employee wasn’t at fault?

If the other driver was primarily at fault, it’s usually possible to recover workers’ compensation benefits paid from the negligent driver’s personal auto insurance carrier.

In many cases. SFM can recover 100 percent of the workers’ compensation benefits paid, but there are often situations that restrict us to recover only a portion of the total.

The reasons for this include:

• Some states have statutes that allow the employee’s personal injury attorney to take the first third of the settlement
• The other driver might not be 100 percent at fault, meaning the employee bears some responsibility
• Not all workers’ compensation benefits are recognized by auto insurers. For example, payments for rehabilitation services are often questioned by liability carriers because this is not a standard benefit paid under a liability claim in many states
• The driver’s auto insurance policy limits might be less than the amount of incurred workers’ compensation benefits

Make sure employees who drive for work know what to do if they’re involved in an accident

Hopefully, you and your employees won’t ever have to worry about dealing with a car crash, but it’s always best to be prepared.

Making sure your employees know what to do in the event of a crash can save you, and your employees, major hassles down the road.

Lastly, it is worth noting that educating employees who drive for work about safe-driving practices is always a good idea. Check out a few of our resources:

• Safe driving practices for employees
• Creating a policy for employee cell phone use while driving
• Eight tips for defensive driving
• Defensive driving: Supervisor Initiated Training tool

Originally posted June 2017; updated in February 2024.

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

Opioid-involved drug overdoses topped 100,000 in 2022, according to the Centers for Disease Control and Prevention (CDC).

And another 10 million people misused prescription opioids in 2019, reports the U.S. Department of Health and Human Services .

Opioid painkiller misuse has become widespread, affecting every facet of life – and that includes the workplace. It not only threatens the general well-being of employees, but it can also create on-the-job safety risks and inhibit recovery and return-to-work.

Opioids do have their place when properly prescribed and used, but their misuse can have devastating effects on your employees.

Here are some basics for employers on opioids and opioid misuse:

What are opioids?

Opioids are narcotic painkillers that work by preventing pain signals from reaching the brain. They are synthetic drugs that resemble the effects of natural opium, derived from the opium poppy. OxyContin and Percocet are a couple of the popular brand-name opioids, but there are many more. Taking them may produce a euphoric effect, or “high.”

Why are they prescribed?

Opioids are generally recommended for short-term pain relief due to injury, surgery, disease or cancer treatment, or as a palliative measure for the terminally ill, but doctors also prescribe them to address chronic pain.

However, due to increasing opioid prescriptions for chronic pain, and a related increase in overdose deaths, the CDC issued guidelines for prescribing opioids. The guidelines are intended for primary care clinicians and other clinicians providing pain care for outpatients 18 years or older with:

• Acute pain (duration less than 1 month)
• Subacute pain (duration of 1-3 months)
• Chronic pain (duration of more than 3 months)

Are they necessary and effective?

Studies show that long-term use of high doses of opioids usually isn’t the best treatment for chronic pain, unless the patient is terminal.

In fact, nonopioid therapies are at least as effective as opioids for many common types of acute pain, according to the CDC.

“Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient,” reads a portion of the guidance from the organization.

Using the drugs long term can actually increase a patient’s sensitivity to pain, requiring higher doses for the same level of pain relief. This escalating dosage pattern can contribute to opioid addiction. Also, opioids are not among the most effective – or longest lasting – options available for relief from acute dental pain, an examination of the results from more than 460 published studies has found.

In addition to the risk of tolerance and addiction, other side effects of taking opioids can include: constipation, nausea, vomiting, dry mouth, sleepiness, dizziness, confusion, depression, lower testosterone (resulting in lower sex drive, energy and strength), itching and sweating.

What about other treatment options?

A 20-year analysis of health care treatment released in early 2024 revealed a significant rise in use of complementary health approaches, such as yoga and meditation, especially for pain management.

The analysis , conducted by the National Institutes of Health’s National Center for Complementary and Integrative Health and published in the Journal of the American Medical Association, found that the percentage of individuals who reported using at least one of seven alternative approaches to care increased from 19.2 percent in 2002 to 36.7 percent in 2022.

For pain management, the use of alternative therapies increased from 42.3 percent in 2002 to 49.2 percent in 2022.

Researchers utilized data from the 2002, 2012 and 2022 National Health Interview Survey to evaluate changes in the use of seven complementary health approaches, including yoga, meditation, massage therapy, chiropractic care, acupuncture, naturopathy and guided imagery/progressive muscle relaxation.

How likely is it that one of my employees will suffer from opioid addiction?

In 2022, there were 39.5 prescriptions written for every 100 people in the U.S., although some counties had rates above 51 per 100 people, according to CDC prescribing rate maps . That 39.5 figure is down from 46.8 in 2019.

Opioid abuse has become so pervasive that any employer should be conscious of the possibility that an employee could be affected. The U.S. Health and Human Services Department declared the opioid crisis a public health emergency in 2017.

About 3 million people in the U.S. have had or currently suffer from what the National Library of Medicine calls opioid use disorder (OUD) as of July 2023. The group says the increase in OUD can partially be attributed to the overprescribing of opioid medications.

As an employer, how does this issue affect me?

The most important aspect of the opioid addiction epidemic is its potential to significantly impact the well-being of your employees, whether they themselves are misusing the drugs, or they’re dealing with the stress of a loved one’s addiction. Any drug addiction can have numerous negative effects like harming family relationships, threatening financial stability and even causing death.

Employee opioid use can also affect workplace safety. Employees taking opioids (even if not addicted) could pose a safety risk to themselves and other employees, depending on the kind of work they do.

• The behavior of someone on opioids can be similar to that of someone who has been drinking
• Jobs that involve working from heights, being on construction sites and driving are among those that cannot be safely performed while on opioids

An employer might choose to have a policy preventing employees from performing these kinds of tasks while taking drugs, like opioids, that can diminish alertness.

State laws differ on employee drug testing, and additional legal issues such as compliance with the Americans with Disabilities Act can come into play, so it’s wise to consult legal counsel before instituting a formal policy.

What’s being done to combat the trend of opioid abuse?

Medical providers, pharmacists, insurers and government agencies are all taking steps to combat the epidemic.

Doctors are assessing patients’ risk factors for misuse of opioids more carefully before prescribing them. More doctors and pharmacists are also participating in prescription monitoring programs, which are statewide databases listing all prescriptions of controlled substances and when those prescriptions are filled.

These systems allow doctors, dentists, pharmacists and law enforcement to see whether a patient is getting multiple prescriptions from different doctors, or filling the same prescription in multiple places.

Some physicians also use narcotics contracts to better control patients’ use of opioids. These contracts typically prohibit a patient from getting pain medication prescriptions from other doctors. Many physicians will obtain random drug testing to ensure that patients are taking their medications as prescribed.

Insurers are often requesting peer-to-peer reviews when they question whether an injured employee is being prescribed the most appropriate medications. In these cases, a pharmacist and pain management specialist will look at the case and talk with the treating physician about their course of action. SFM has expert staff who review opioid prescriptions and works with treating physicians and claimants to help wean them off the drugs.

Lastly, the CDC has issued federal guidelines for prescribing opioids for chronic pain. The states of Minnesota, Wisconsin, and many others, have issued state treatment guidelines.

Additional resources

• National Safety Council opioid resources
• Opioid Epidemic Response: Employer Toolkit

This blog was originally published in December 2022 and updated in February 2024 with new information and additional research.

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

Many employers don’t realize how much control they can have over their workers’ compensation premiums.

Because premiums are based partially on your loss history, you can avoid future premium increases (and maybe even see some reductions) if you take steps to prevent injuries and ensure your claims are well managed.

Of course, it’s always a good idea to get ahead of potential injuries. Being proactive and building a safety culture in the workplace helps. This can include:

• Creating safety committees
• Implementing safety walks
• Checklists to encourage safety
• Regular safety discussions between employees and leadership

Below are some of our top tips for controlling your losses and, as a result, your workers’ compensation premiums.

1. Have a list of transitional jobs ready for when you need it

List light-duty, transitional jobs that fit within a variety of work restrictions.

That way, when employees are injured, you can easily identify jobs that fit within their restrictions and get them back to work quickly. Delays of even a day or two can increase claims costs substantially by triggering wage-loss payments that would otherwise be unnecessary.

2. Consider all your options to bring the employee back to work quickly

Bringing employees back to work when they’re still recovering can sometimes require a little creativity. A few options include:

• Reducing the employee’s work hours or work days
• Bringing the employee back in a different position at a reduced wage
• Modifying the employee’s equipment or work area
• Swapping tasks with other employees or reorganizing work within the injured employee’s group
• Arranging for temporary work in a different area of the company
• Creating a new lighter-duty job that will be transitional and temporary

Many employers don’t realize that if they bring injured employees back to work at less than their full pre-injury wage, their workers’ compensation insurance will make up most of the difference.

3. Have a relationship with an occupational health clinic

Quality of treatment counts for a lot in medical costs and outcomes.

To find a good clinic, ask officials there whether they have experience treating injured employees and accommodate return to work so the employee can heal while on the job. Ask what information they’ll need from you in the event of an injury, such as an injured worker’s job description.

4. Have a point person for return to work

It helps to have one person who is accountable for getting injured employees back to work as soon as medically possible.

This generally includes staying in contact with the employee, working with the treating doctor and involving the employee’s supervisor.

5. Ensure that employees understand and follow any work restrictions

When injured employees don’t follow their doctors’ restrictions, it can result in costly claim complications.

Take the time to go through employees’ restrictions with them and discuss any aspects of the job that could cause them to do work beyond what their doctor has permitted. Also make sure they know they should follow their restrictions both at work and outside of work.

6. Stay in contact with your injured employees

Let injured employees who are off work know that you are concerned about their injuries and recovery, that you value what they bring to the organization and that you are looking forward to their return.

Keep up on the status, expectations and return-to-work date for each injured employee. Have a plan and stay in touch with the employee, supervisor and claims representative to make sure things stay on track.

7. Report injuries right away

As soon as you learn of an injury, the clock starts ticking toward state deadlines for paying or denying benefits.

Reporting right away keeps you in compliance with these laws and regulations, and allows your claims representative to be responsive to your employees. Delayed reporting can result in longer-duration claims and higher costs. (See our injury reporting page for ways to report.)

Watch out for communications breakdowns. Employees and supervisors need to know who to contact when an injury occurs, and your organization’s point person for reporting claims needs to act with a sense of urgency.

8. Analyze past injuries

Anytime an injury occurs, conduct an accident analysis to identify what caused it and how similar accidents can be prevented in the future.

You can also use your loss history reports to help spot problem areas and identify opportunities to improve safety.

9. Develop a wellness program

Studies show there is a connection between health issues — such as obesity, diabetes and hypertension — and higher workers’ compensation costs.

But that’s only one benefit of finding ways to encourage wellness among your workforce. Encouraging healthy lifestyles can also raise productivity and reduce health care costs.

Bonus tips

Hire smart

Make sure you’re hiring the best possible employees. Legally, you can’t ask job candidates whether they’ve had past workers’ compensation claims, but you can explain the job and its requirements and ask during the interview or in an application whether the applicant can perform the essential functions of the job. Be sure to explain the importance of safety, especially in jobs involving physical labor. Take the time to look into candidates’ backgrounds and talk to their former employers.

Pay close attention to safety

Establish good safety rules and watch for things that cause workplace accidents. Look for any patterns in what’s causing injuries. Correct employees with unsafe habits and promote the importance of workplace safety.

Originally posted May 2017; updated January 2025.

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

It’s not hard to find a story on prescription drugs in the headlines.

Maybe you’ve seen news reports on topics such as:

• Prescription drug abuse, which has reached epidemic proportions
• Arguments of overmedication and the push for non-pharmaceutical or non-narcotic alternatives
• Lack of affordability, with pricing increases far outpacing inflation

These issues and many more can come into play when prescription drugs are needed to treat work injuries.

That’s why SFM works hard to make sure injured employees’ medications are managed well. As part of that effort, we partner with pharmacy benefits manager, myMatrixx .

myMatrixx negotiates pricing for prescription drugs and monitors whether comparable, lower-cost drugs might be available. But its services go beyond cost savings. SFM and myMatrixx work together to see that injured employees are getting the best prescription drug treatments for their injuries and aren’t being put at risk for addiction or dangerous interactions.

The safety of our injured employees is critical.

As a pharmacy benefits manager, myMatrixx acts as an intermediary between SFM and pharmacies, negotiating and paying for medications needed to treat work injuries and connecting the appropriate representative when the medications require approval.

myMatrixx has pharmacists on staff who work together with SFM’s medical experts.

How does SFM ensure injured workers are getting safe and effective prescription medications?

myMatrixx provides SFM with reports that give us the opportunity to monitor injured employees’ prescriptions. This allows us to address dangerous combinations of drugs, prescriptions that are higher or lower than recommended doses of medications, and ineffective treatments for injuries.

For example, in one case an employee complained that his prescription drug wasn’t helping him. SFM discovered he wasn’t taking a high enough dosage for it to work.

If there is any concern about a drug(s), SFM can send a letter to the employee’s doctor. Optimal, safe and appropriate medication management is our goal.

How do SFM and myMatrixx control prescription drug costs?

The cost of prescription drugs in the U.S. increased 15.2 percent from 2022 to 2023, according to an October 2023 report from the U.S. Department of Health and Human Services. In fact, more than 4,200 drug products saw price increases.

However, it should be noted that the Inflation Reduction Act, passed in 2023, has a provision aimed at lowering prescription drug costs.

Still, prescription drug spending increased 8.4 percent to $405.9 billion in 2022, according to the Centers for Medicare and Medicaid Services .

Costs for individual drugs can vary widely, sometimes for no obvious reason. Here are a few examples of surprising variations in prescription drug pricing:

• When a manufacturer changed its pricing in January 2023, one drug’s cost went up 3,000 percent
• Some drugs can vary from $15 per dose to more than $140 at pharmacies within a single ZIP code
• A generic medicine could cost $7 or $393 depending on where it was purchased

The world of prescription drug pricing can be complicated at best and downright baffling at worst.

This is why working with a pharmacy benefits manager is so important.

myMatrixx negotiates with its network of 65,000 pharmacies on drug pricing and monitors prescriptions to identify whether identical or comparable drugs might be available at lower prices.

What is SFM doing to prevent opioid addiction?

One major reason prescription drugs have been getting so much attention recently is the sharp increase in prescription painkiller addiction as well as other medications and/or concerning combinations of medications, both legal and illegal.

SFM helps prevent addictions and advocates for weaning patients off the drugs, or at least getting them to a safer dosage.

Company officials send letters to treating physicians of injured employees who’ve been prescribed high doses of opioid painkillers or other drugs of concern, asking them to develop plans to wean the patients off of the drugs. With increased awareness of the dangers of opioids as well as other prescription medications/combinations and the concerns for prescription use disorder or addiction, more and more doctors are complying.

According to CDC, chronic pain is a pervasive health condition affecting as many as one in five adults and nearly one-quarter of them have used a prescription opioid in the past 3 months and this is associated with increased risk for misuse, addiction, morbidity and mortality.

In some cases, injured employees themselves request to be weaned off the drugs due to safety concerns after seeing the letters outlining the risks.

Sometimes, simply tapering down the medication over time isn’t a safe option. In cases of long-term, high-dose opioid use, other dangerous drug combinations, or both, SFM has sent injured employees to rehabilitation programs. These programs focus on non-medication pain management treatment/alternatives as they help people stop using their opioid painkillers.

Overall, SFM has been successful in helping many of our injured employees taking opioids or other prescription drugs discontinue use or decrease to a safer dosage.

Originally published November 2021; updated January 2024.