Frequently Asked Questions

1.  What is Worker's Compensation?  

Worker's Compensation is a remedy that was created by the Legislature in order to provide compensation for those who were injured on the job. Prior to worker's compensation it was necessary for an injured party to prove that the employer was negligent and it was that negligence that caused the employee's injuries in order to obtain recovery. Many injured employees were left without compensation and unable to work thereafter. In most State's,  Worker's Compensation Acts offer benefits to entitled injured workers through the form of medical treatment, lost wages, and payment for permanent disability.

2.  Is Workers Compensation mandatory?

 In most States, all firms are subject to the Workers Compensation statute and all are required to carry Workers Comp insurance.

3.  Are there any exceptions?

The only exception is that coverage is voluntary for employers with one or two employees.  There are, however, special rules that apply to partners, sole proprietors, and corporate officers.

4.  What are these special rules?

Coverage is elective for partners and sole proprietors.  Corporate officers may reject coverage under the policy if they wish.  A signed form is usually necessary to elect or reject coverage.

5.  What if a corporate officer does not take a salary?

The payroll used to calculate premiums for corporate officers is subject to a minimum of $7,800 annually and a maximum of $26,000 (Virginia).  Most all States have this rule, however the dollar amount may change from State to State.

6. What is a worker's compensation injury?

In order to have a compensable worker's compensation injury you must have been injured by an accident that arose out of and in the course of your employment.

7. What should I do if I get injured on the job?

If you are injured on the job the very first step is to notify your supervisor. Make sure that an accident report is filed with the appropriate personnel of your employer. Even if your injuries are not serious you must still report your injuries as they become more problematic at a later date and failing to report them may hinder your claim. In addition if you need medical treatment then request it when you file your report with you employer.

8.  What is workers' compensation fraud?

Fraud usually involves six elements:

·         False information given by an insured employer, an injured worker, a witness, another person involved in a claim, an insurance company or a claims adjuster working for an insurance company.

·         The false information is spoken or put in writing.

·         The person who gives the information knows it's false.

·         The false information is meant to prove, validate, affirm or deny a claim for injury or loss payment, or to obtain insurance coverage.

·         The false information must be given with intent to defraud.

The false information must relate to the case (i.e., change the way the claim was handled, investigated, evaluated or settled).

9.  Is workers' compensation fraud defined the same way in every state?

No. The definition varies by state. In most states, however, the law applies to any person, including insured employers, insurance companies, injured workers, doctors, claims adjusters and others involved in a claim.

10.  Why should I report workers' compensation fraud?

Workers' compensation fraud not only impacts the insurance company that pays the false claim, but it can also raise your insurance cost. This in turn harms your customers because the higher premium you must pay for insurance gets passed onto them.

11.  What type of fraud occurs most often?

The four most common types are:

1.    Employee fraud: Worker knowingly files a claim for an injury that did not occur on the job, or the worker misrepresents facts to receive greater benefits.

2.    Medical Fraud: Medical provider bills for services not provided, intentionally inflates charges for services, or bills for services provided by non-licensed or unqualified personnel.

3.    Premium fraud: Employer intentionally underreports the number of claims, the number of employees or amount of payroll, or misclassifies employees to affect the price of coverage.

4.    Employer fraud: Employer denies benefits to an employee by not reporting a claim or encouraging employees not to report a claim.