Workers’ compensation claims are generally segmented into four categories: incident only, medical only, lost time, and death. For any claim, though, compensation is based on injuries tied to the employee’s job responsibilities. If workers get hurt while doing a job for another company or participating in social activities, the policy won’t cover them.

Incident only
This is the most straightforward claim. An employee slips and falls or pulls a muscle, for example, and immediately reports the incident to his manager or HR department. The claim then goes to the insurance agency for processing. The agency will determine what compensation and benefits to pay out, if any. Incident-only claims must be filed as soon as possible, or your company can face fines and penalties.

Medical only
Employees who suffer injuries requiring basic doctor visits and follow-up appointments are eligible for medical expenses beyond what health insurance will cover. If the doctor determines an employee can go back to work immediately, your insurance policy won’t pay out any other compensation.

Lost time
Lost time claims pay benefits when employees can’t return to work. There are three types of lost time benefits:

1. Temporary total disability – Employee can’t perform the job because of the injury suffered but should be able to return once the injury heals (example: truck driver with a broken foot or machine worker with a badly cut hand). Employees on temporary total disability collect workers’ compensation benefits while convalescing.

2. Permanent total disability – Employee can’t return to work in any capacity. The injury either crippled the employee or caused loss of limbs essential to job performance. This typically provides the full allotted workers’ comp benefits for the employee.

3. Partial disability – A mix of temporary and permanent disability. Employee’s injury may allow him to return to the work in a limited capacity for a portion of his salary, while the insurance claim pays the difference.

Death
An employee dies from injuries or illness suffered on the job site. The employee’s family is eligible for compensation and benefits through your policy.

Preventing fraud
The National Insurance Crime Bureau lists workers’ compensation claims fraud as the fastest growing insurance scam in the country. Unscrupulous workers who feign back injuries, knee tweaks, or chronic fatigue syndrome to secure benefits cost insurance companies millions of dollars. In turn, you end up paying higher premiums for your coverage.

The Coalition Against Insurance Fraud suggests you immediately contact your insurer anytime you suspect fraud. Your insurance company can call in an investigator who can observe employees outside the workplace to see if they are performing strenuous activity unrelated to their jobs, or earning another paycheck while collecting benefits. They can also research if the employee was:

• under the influence of drugs or alcohol
• concealing a previously existing medical condition that caused the accident
• engaged in unsafe work practices that violate corporate policy