When an employee experiences a traumatic event at work, workers’ compensation coverage is probably the last thing on your mind. But knowing how post-traumatic stress disorder (PTSD) is defined and covered in your state can help you make sure your employee gets needed help.

For PTSD to be covered by workers’ compensation, it must meet the criteria as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, and be diagnosed by a psychologist or psychiatrist.

By definition, symptoms must last or start a month or more after the event to be considered PTSD. Symptoms that last less than a month are considered acute stress disorder. This nuance is important when it comes to how different states handle PTSD claims.

Some states specifically address PTSD in their workers’ compensation laws. In other states, whether PTSD is covered depends on what caused it and whether the state recognizes that event as a work injury.

If the event that led to PTSD was physical, most states will recognize that as a physical/mental injury (that is, a mental injury caused by physical injury) and treatment for PTSD will be compensable. If the employee was involved in a traumatic event, but there was no physical injury, some states may not recognize PTSD as a claim. This is referred to as a mental/mental injury.

Here are the specifics on PTSD in SFM’s core states:

• Minnesota
  PTSD is specifically addressed in the statute. If an employee is diagnosed with PTSD by a licensed physician or psychologist and the employee meets the Diagnostic and Statistical Manual of Mental Disorders criteria, the claim is covered by workers’ compensation benefits. This is the only type of mental/mental claim recognized in Minnesota. If PTSD is diagnosed as arising from a physical injury, that would be compensable in Minnesota as a physical/mental claim. For injuries occurring after Jan. 1, 2019, it will be a presumption that PTSD in first responders is compensable under workers’ compensation, absent preexisting history and limited statutory exceptions. PTSD claimed due to job performance issues, such as demotions and layoffs, is not compensable.
• Wisconsin
  PTSD is not specifically addressed in the statute. Mental/mental injuries can potentially be compensable if the circumstances causing the injury arise from extraordinary stress. It must be a far greater stress than the expected emotional strain that employees encounter daily without serious mental injury.
• Iowa
  Mental/mental injuries are recognized, but in order to be compensable under Iowa law, the work condition and circumstances lead­ing to the mental condition must exceed that which is typically experienced by peers in that same profession. PTSD may be compensable without any physical injury to the body under these circumstances.
• Nebraska
  Mental/mental injuries are not compensable in Nebraska, so a diagnosis of PTSD without any physical injury would typically not be covered. If there is a physical injury to the body and PTSD is a condition that is a result of that injury, it could be compensable as a physical/mental injury. However, first responders are an exception. PTSD could be compensable as a mental/mental injury for first responders who are exposed to extraordinary and un­usual stimuli in comparison to normal conditions of their employment. Nebraska statute defines first responders as sheriffs, deputy sheriffs, police officers, state patrol troopers, volunteer or paid firefighters, emer­­gency medical technicians and paramedics.
• South Dakota
  South Dakota does not cover mental/mental injuries. There must be a physical injury to the body. If an employee sustains a physical injury and claims PTSD as a consequential injury, then it could be compensable.

Intervene early to help employees who’ve experienced trauma

Although PTSD cannot be diagnosed until 30 days after a traumatic event, you shouldn’t wait that long to reach out to your employee. Early intervention can prevent situational anxiety from progressing to PTSD.

Encourage any employee who may be susceptible to seek help through your employee assistance program, SFM’s Injured Worker and Family Assistance Program or from a psychologist or psychiatrist.

If someone has experienced trauma, be it physical or mental, coping skills for them to be more resilient so they can manage their stress and anxiety could be vital. Treatment is typically cognitive behavioral therapy (CBT). Symptoms can often be effectively managed to restore the individual to normal functioning.

SFM’s claims representatives spend all day managing workers’ compensation claims. They coordinate with injured workers, employers and medical providers. Many of them have decades of experience in the field. So, when we asked them to give us their top tips for employers, they delivered.

Here’s what the claims adjusters said:

• When hiring, include the physical demands of the job in the job description. Have prospective candidates sign off on the descriptions to signify that they can perform the essential functions of the job. Pre-employment physicals and criminal background checks are also important.
• Always investigate after an injury. Document how, when and where the accident occurred. Talk with the injured employee and witnesses, and take photos. If you have surveillance cameras in the area, let the claims representative know. Then figure out how to prevent it from happening again. This information also helps claims representatives to verify what they are told by the injured worker.
• When bringing employees back to work, work together with the employee to look for ways they can perform their job within their medical restrictions. Your claims representative can also provide suggestions and resources if needed. Require the employee and supervisor to commit to working within those restrictions. It’s always good to put it in writing and get everyone to sign off.
• Be sure to tell your claims representative right away when an employee starts needing time off for a work injury and when the employee returns to work so that benefit payments are on time and correct.
• Focus on building strong relationships between employees and direct supervisors.
• Continue communicating with injured employees, even if they are totally disabled and unable to return to work. Keeping the lines of communication open and letting employees know you care about them is really important.
• Address disciplinary issues with staff right away. If you don’t, and the employee is injured, these issues become much more difficult to deal with.
• If an employee is injured in a work-related automobile accident, be sure to send the claim to both your workers’ compensation and auto insurer. If the injury is work-related, workers’ compensation provides primary coverage, and your insurer will pursue recovery from an at-fault party.
• Make a copy of any paperwork an injured worker brings in, especially any doctor’s reports, and forward to the claims representative.
• Report all claims right away.
• Allow your claims representative to deliver hard-to-hear news to the injured worker versus doing it yourself. That helps you maintain a positive relationship with the employee, which is more conducive to a speedy and effective return to work.

 For more tips, read four things you need to do after an employee is injured.

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

Fast, accurate injury reporting can reduce frustration for everyone involved.

Sometimes it can even reduce costs by preventing:

• State penalties
• Litigation
• Delayed return-to-work
• Low employee morale
• Unnecessary medical costs

Following are some of the most common reporting mistakes we see, and ways you can easily avoid them:

• Not indicating that an employee is missing work due to a work injury.
  As soon as your employee begins losing time from work due to the injury, let your claims representative know, so the employee receives wage-replacement benefits on time. Failing to do this can lead to state penalties and financial hardship for the employee.
• Reporting late.
  As soon as any supervisor, manager or claims coordinator becomes aware of an injury, the clock starts ticking toward your state’s deadline to determine whether the employee is due workers’ compensation benefits. Missing the deadline can result in significant state penalties. Reporting right away gives your claims representative enough time to investigate the injury before the deadline. See the How to report a work injury page for details on how to report.
• Incomplete forms.
  If you choose to report your claim by filling out a form, leaving off important information can delay processing of a claim. Especially important details include: Social Security number and date of birth of the employee, date of injury, date of first day of lost time, date employer was notified about injury, and contact information.
• Communications breakdowns.
  Make sure employees and supervisors understand the process for reporting a work injury at your organization. Delays in reporting injuries sometimes occur because employees simply don’t know who to tell if they are injured.
• Including sensitive information in first reports.
  In some states, including Minnesota, the injured employee is entitled by law to receive a copy of the First Report of Injury. If you suspect fraud, or have other sensitive information about the incident, report it to your claims representative separately or report your concerns through our website. If you report through the SFM Work Injury Hotline, you can call or email your claims representative about your concerns. If you report the injury using a form, you can write it on a separate piece of paper and attach it to the first report. If you report online, you can type it in the confidential comments box on SFM’s online First Report of Injury.
• Not reporting questionable claims.
  Sometimes employers don’t report an injury because they think it is suspicious, or not serious enough to report. This is a violation of state laws, which require the employer to report any injury claimed by an employee. Instead, report all injuries, but let your claims representative know about your concerns. Your claims representative will investigate the claim and its circumstances.
• Sending a First Report of Injury to your agent.
  Please report workers’ compensation claims directly to us. Sending them to your agent can delay our receipt of the report, which can hamper our ability to investigate and respond promptly to the claim.
• Filing in the wrong state.
  For employers with multiple locations, sometimes there’s confusion over which state to file the claim in. Due to the differences in states’ workers’ compensation laws, this can sometimes be difficult to determine. A good rule of thumb is to file in the state where the employee was hired or typically works. When in doubt, it’s still best to make the report right away and let your claims representative know that you have concerns.

This post was originally published on June 18, 2013, and updated on June 15, 2021.

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

A workers’ compensation “waiting period” is the number of days an employee must be off work before receiving wage-loss benefits.

This waiting period is established by state law, and differs from state to state.

It’s worth knowing your state’s workers’ compensation waiting period and the rules surrounding it, because bringing injured employees back to work within this timeframe whenever possible is one of the most important things you can do to control future premiums.

Bringing an employee back to work before the state’s waiting period ends will keep the claim “medical only,” which means claim costs will be reduced by 70 percent when determining your experience modification factor (e-mod).

Waiting periods and rules differ by state

It’s not always easy to figure out when your employee’s waiting period ends due to factors like weekends or partial days.

Different states handle these issues differently.

In all of SFM’s core states of Minnesota, Wisconsin, Iowa, Nebraska and South Dakota, days the employee isn’t scheduled to work (such as weekends) generally count toward the waiting period, with one important exception. In Wisconsin, Sundays do not count unless the employee was scheduled to work.

This means in Minnesota and Iowa, if your employee is injured on a Friday, the waiting period would be Friday, Saturday and Sunday, and benefits would be due on Monday. Therefore, you may have only until Monday to bring the employee back to work to avoid a lost-time claim.

Wisconsin is also the only state of the five where the waiting period does not start until the first full day of missed work. In the other four states, the waiting period starts on the first full or partial day of missed work.

Waiting periods in MN, WI, IA, NE, KS and SD

The following are the waiting periods in SFM’s core states:

• Minnesota: 3 days
• Wisconsin: 3 days
• Iowa: 3 days
• Nebraska: 7 days
• Kansas: 7 days
• South Dakota: 7 days

Days before wage-loss benefits are paid retroactively

State law also defines how many days an employee must be off work to be retroactively paid wage-loss benefits for the waiting period days that were not initially paid.

For example, in Iowa, this number is 14 days. This mean an employee who is off work for 20 days due to a work injury would receive wage-loss benefits for the first three days of time off, but an employee who is off work for 10 days would not.

Again, this number differs by state. The following are the number of days an employee must be off work to be retroactively paid wage-loss benefits for the waiting period:

• Minnesota: 10 days
• Wisconsin: 7 days
• Iowa: 14 days
• Nebraska: 6 weeks
• Kansas: 3 consecutive weeks
• South Dakota: 7 consecutive days

Bringing employees back to work

In many cases, a doctor may allow an injured employee to return to work, but not to their regular job. At times like these, it helps to be prepared with a list of light-duty jobs in advance. For ideas, find lists of light-duty jobs by industry in our blog post Free return-to-work resource provides ideas for light-duty jobs.

If you want to lower your workers’ compensation premium, it’s worth learning about a little number called your e-mod.

Why? Because your premium is determined, in part, by your e-mod — and it’s one factor you can actually manage.

So what does e-mod stand for?

E-mod is short for experience modifier or experience modification factor.

The experience modification factor is a multiplier used to calculate your workers’ compensation premium. It shows how your organization’s workers’ compensation claims experience compares to other businesses similar in size and types of jobs.

If your claims history is average among similar businesses, your e-mod will be 1.0. If your e-mod is:

• above 1.0 it means your business’ claims history is worse than your peers.
• below 1.0 it means your business’ claims history is better than your peers.

An e-mod less than 1.0 directly reduces the premium amount you pay. The lower your e-mod, the greater the reduction.

That’s the short answer. The longer answer is valuable to know if you want to really take control of your workers’ compensation costs.

What goes into the e-mod calculation?

The e-mod usually takes into account three years of claims history, excluding the most recent policy year. For example, the e-mod for a policy period beginning January 1, 2023, includes claim costs for the policy periods beginning:

• January 1, 2021
• January 1, 2020
• January 1, 2019

Who determines your e-mod?

A state or national rating bureau — not your insurer — calculates experience modification factors.

Depending on your state, either your state rating bureau (such as the Minnesota Workers’ Compensation Insurers Association or the Wisconsin Workers’ Compensation Rating Bureau) or the National Council on Compensation Insurance determines your e-mod. These data collection organizations use statewide claim data to calculate expected losses for different types of operations.

They also calculate individual employ­ers’ e-mods using the claims cost data reported by insurers.

Your data collection organization recalculates your e-mod each year about 90 days prior to your policy renewal date and reports it to you and your workers’ compensation insurer.

Who gets assigned an e-mod?

Not every business is large enough to have an e-mod.

Your workers’ compensation premium has to be above a certain dollar threshold specified by your state before your organization will be assigned an e-mod. This minimum premium amount is usually around $3,000-$7,000.

Which claims costs are excluded from the e-mod?

Not all claims costs are included in the e-mod calculation.

If a claim is medical-only (meaning the employee doesn’t miss any work time due to the injury, or returns to work within the state waiting period), only 30 percent of the claim costs are included in the e-mod calculation. That’s one of the many reasons for a strong return-to-work program.

If the claim is larger, typically involving lost time, there is a discounted rate for losses over a certain amount. This is known as the split point, and is set by each state. For example, in Minnesota in 2023, the split point is $18,500. That means that when the e-mod is calculated, less weight is given to a claim’s dollars over $18,500.

Where to find your e-mod

If your organization is large enough to have an experience modifier and you’re an SFM policyholder, you can find it in three places.

1. The official notice you receive from your rating bureau each year prior to your policy renewal date
2. Your SFM policy information page
3. In CompOnline under the “Policy” tab, on the “Policy information” screen

How to calculate your e-mod yourself

You may want to try to figure out what your e-mod will be following a significant claim, or test out “what if” scenarios.

Each state rating agency calculates e-mods differently, so this isn’t always easy.

The Minnesota Workers’ Compensation Insurers Association offers a free Minnesota Experience Modification calculator . The Wisconsin Compensation Rating Bureau and National Council on Compensation Insurance (rating agency for Iowa, Nebraska, Kansas and South Dakota) offer similar tools for a fee.

To learn more about the e-mod calculation formula in your state, see the following resources:

• Minnesota: Experience rating frequently asked questions
• Iowa, Nebraska, Kansas and South Dakota: ABCs of Experience Rating brochure

Keeping an eye on your e-mod is a good habit that will help you understand and then work on lowering your workers’ compensation premium.

Learn more in SFM’s E-mods CompTalk .

A workplace injury just occurred. The injured worker received appropriate medical care. What do you do next?

Poor accident analyses can cause more accidents, because they likely do not identify root causes. Without identifying root causes, your corrective actions could simply be guesses. If you’ve prepared an accident analysis plan ahead of time, you’ll feel confident that you’re taking the correct steps to investigate and address the causes, so you can prevent similar incidents in the future.

You’ll demonstrate your commitment to a safe work environment while avoiding injuries and unnecessary financial costs.

Make a plan

To be ready to act when the time comes, you’ll need a post-accident analysis plan. These four steps will help you create a blueprint for investigating that you can initiate immediately following an incident:

1. Determine who should investigate workplace accidents

The right investigator may be the supervisor, who knows the employees involved and the job functions. Investigations could also be led by members of your safety committee, management, safety personnel or a third party.

2. Create a written plan

In the plan, be sure to include:

• The purpose of investigating incidents. Make it clear the goal is to identify causes and make corrections, not to place blame.
• Who will initiate and conduct each investigation, who will review the findings and who will implement corrective action.
• What types of incidents must be investigated. You may decide to investigate all medically treated incidents, or near misses that could have resulted in severe injuries. Many companies with the best loss prevention track records have policies to investigate all incidents.
• When, where and how to investigate for timely and thorough results.

3. Provide training on how to investigate

Teach the four-point approach to accident investigations to anyone you’ve identified as investigators. Use our Accident Analysis Worksheet as a guide.

4. Communicate your accident investigation policy

Communicate to everyone in the company your commitment to investigating and preventing accidents. Depending on your organization, this may be a policy in your employee handbook.

Now you have an accident analysis plan ready to be put into motion after any incident.

The four-point approach to investigation

If an injury occurs, use your plan and this systematic approach to investigate.

1. Collect data

Ideally, accidents should be investigated right away. Talk to witnesses as soon as possible. Take pictures and review maintenance and training records.

2. Identify the causes

By identifying the causes (there could be several), you can reduce the risk of a similar incident occurring. Accident investigation looks at four possible causes:

• Equipment: Is it working properly? Are the guards and other safety precautions present and functioning?
• At-risk behaviors: Were there safety procedures that weren’t implemented? Are safety procedures routinely enforced? Was the employee working alone?
• Personnel: Was the employee properly trained for this particular job? Which shift was the employee working, and how long was the employee’s shift? Was the employee wearing personal protective equipment?
• Environment: Was the work area properly lighted? Were work surfaces and the floor free of clutter? Was noise an issue? What about chemicals or dust? Was space sufficient to do the task? Was the workspace adjusted to the employee’s ergonomic needs?

3. Analyze the findings

Examine the facts and observations. Distinguish between immediate causes and underlying causes. Immediate causes could be things like a broken rung on a ladder or other mechanical failure, or an unsafe actions such as running instead of walking. Underlying causes are things like poor machine maintenance, a missing machine guard, a crowded work area or lack of training.

4. Develop a plan for corrective action

Here’s where you have a chance to learn from what’s happened and take steps to prevent it from happening again. Make recommendations to remedy each of the possible causes you identified. For example, you might suggest changes to machinery, work procedures, employee training, safety process or personnel.

By thoroughly analyzing all of the contributing factors in a workplace accident, you’ll be able to eliminate risks and make changes that could prevent a future injury.

Test your report

Double-check that your analysis does the following:

• It addresses causation and uses the model the organization has selected.
• A person who is unfamiliar with the workplace and the process can understand what happened.
• The report avoids acronyms and industry-specific language that someone outside the organization would not understand.
• The report is absent of guesswork and reports only facts.
• It includes a process for making and tracking recommendations. Recommendations should be assigned to a specific person.

SFM’s Accident Analysis worksheet offers an easy-to-follow checklist for investigations.

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

Bumps and bruises can happen on the job. Injuries like these are often so incidental they don’t require any medical treatment, and are usually forgotten.

But what if an injury that appeared to be only a bump turned into something more severe?

Most likely, you wouldn’t still have information about the injury on hand. You’d probably also be past state deadlines for injury reporting.

Only about 10 percent of these minor incidents later turn into claims. However, those few could become problem claims if they were not reported early on.

That’s why it’s important to report all injuries, no matter how minor. If an injury requires no medical treatment or lost time from work, it will be categorized as an incident-only report, and have no effect on your injury frequency numbers or experience modification factor (e-mod).

By reporting an incident, you are preserving the necessary information you will need if the injury does later require medical attention or lost time from work. At the same time, SFM does not set aside any reserves for the incident, so the claim is opened and closed in the same day.

How incident-only reporting works

Say an employee bumped his knee. It probably doesn’t seem like a big deal to you or the employee. He told you it hurt a little at first, and that he is now fine. But, as a precautionary measure, you fill out our online injury report form.

You’ll then get a confirmation letter in the mail from SFM’s claims department, stating that SFM received the report, and to contact SFM if the employee needs medical treatment or loses time from work.

Your claims representative may call you to discuss the incident, depending on the nature of the injury. For example, if the incident involved the back, your claims representative would likely follow up, since these injuries can be more involved than they seem.

Tip: If the employee needs medical treatment later or starts missing work, call your SFM claims representative right away. He or she will be able to act more quickly, because the appropriate information is set up. The case can be managed effectively from the very beginning, ultimately reducing the total claim cost.

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

In response to feedback from employers and workers, we’re offering a new option when you call the SFM Work Injury Hotline to report injuries.

When you call during business hours (7 a.m. to 4 p.m., Monday through Friday), you will have a streamlined report-only option for times when your employee would not benefit from speaking with a nurse. This is a good option for cases where the employee is not available for the call, or has already decided whether to get medical treatment.

The option to speak with a nurse will still be available 24/7.

SFM has learned that many employers prefer to report all injuries by phone, so we hope this is a timesaver in cases where the employee does not need or want a treatment recommendation. We want to make it easy for policyholders to report claims immediately through whatever method is most convenient for them.

For times when an injured employee is unsure whether to get medical treatment, the option to speak with a nurse is still available. The nurses are specially trained in responding to work injuries. They will provide a treatment recommendation and also report the injury to SFM.

Calls outside of business hours will automatically be taken by a nurse.

For more information on work injury reporting options, visit our report an injury page.

Ideally, your employees will let you or a supervisor know right away any time they are injured at work, even if it’s a minor injury.

But what if they don’t? Can you be legally required to report an injury that was never reported to you?

In many states, the answer is yes. If you become aware of an injury by seeing it occur, or even suspecting it, it can be considered “constructive notice.” In other words, you should have known.

This matters because there are state deadlines that limit how much time can elapse between the time you become aware of an injury and when workers’ compensation benefits must be paid or denied.

This means that as soon as you’re aware of an injury, it’s important to report it to SFM so your claims representative can investigate and make a determination on whether workers’ compensation benefits are due.

Following are a few things you can do to make sure work injuries are reported right away at your organization:

• Train your supervisors to watch out for work injuries and report them immediately. Make sure they know it’s their responsibility to report all injuries as soon as they learn of them. It’s not up to the employee to decide whether to report.
• Help supervisors remember how to report injuries through the SFM Work Injury Hotline by hanging posters and through other communications.
• Make sure supervisors and employees know that all work injuries, no matter how minor, should be reported immediately.
• If you suspect that the employee was not injured as reported, it’s still important to report the injury right away. Let your claims representative know your concerns. We have the resources to investigate fraud.

When you report a work injury by calling the SFM Work Injury Hotline at (855) 675-3501, you’ll have the option to let your employee speak with a nurse. This is a good option if your employee is unsure whether to seek medical treatment.

Here’s what happens when you call and choose the nurse option:

1. A nurse will answer.

The registered nurse will talk first with the supervisor, and then ask to speak with the employee.

2. The nurse will ask the employee questions about the injury.

These questions will help to determine severity of the injury and the best way to address it. The nurse uses patented software to assist them in asking injured workers the right questions to determine what type of medical care the employee needs.

3. The employee will get a treatment recommendation.

This could range from self-care to a clinic referral or even emergency treatment. If the nurse recommends self-care, instructions can be emailed or faxed to the workplace.

After the call, the nurse will send the report to SFM.

Injured workers who choose to self-treat can call back for further advice if their condition changes or worsens.

How the nurse service is provided

To make nurses available to injured workers, SFM partners with Medcor, a Midwest-based company that has pioneered workplace injury triage since 1997.

Medcor’s nurses are specially trained in responding to work injuries, and they operate under the supervision of a full-time medical director who is board certified in emergency medicine.

They use software that supports the company’s patented methods for making the best triage recommendations for injured employees.

Common questions about the nurse option

Here are answers to some of the questions you might have about the hotline:

• What if the injured employee doesn’t speak English?
  The nurses can access interpreters for more than 200 languages.
• Are third-party administrator, high-deductible and assigned risk plan policyholders included in this program?
  Clients whose claims are administered by SFM Risk Solutions (as a third-party administrator) or Superior Point (for the Minnesota Workers’ Compensation Assigned Risk Plan) are NOT included in this program. Policyholders with deductibles over $100,000 can choose whether to participate. If you are a third-party administration client and need to report, go to the Report a TPA injury page. If you are insured through the Minnesota Workers’ Compensation Assigned Risk plan, report your claims on the Superior Point website .
• Is there any fee for this service?
  No, it is free for most SFM policyholders to call the SFM Work Injury Hotline. The only exception is policyholders with deductibles over $100,000 that choose to participate.
• What if an injured employee disagrees with the nurse’s recommendation?
  It is still up to the employee to decide whether to follow the nurse’s advice.