The responsibilities of dental practice owners extend far beyond patient care. As an employer, you also have an obligation to ensure you are following workers’ compensation laws. Workers’ compensation insurance provides state-mandated benefits to employees who suffer an injury or illness that arose out of or occurred in the course and scope of employment. Your insurance carrier can help you determine the specific obligations in your state, such as compliance postings, statute of limitations and injury reporting requirements.
Other local, state and federal leave laws run parallel and at times intersect with workers’ compensation laws. The Dentists Insurance Company offers workers’ compensation coverage to California Dental Association members, and TDIC’s Risk Management team has answered a wide range of questions that relate to workplace injuries and illnesses, leaves of absence, workplace accommodations and termination. The following are a few common scenarios related to workers’ compensation that have been addressed by analysts.
Scenario 1: Notification of a Workers’ Compensation Injury by a Doctor
A front-office staff member was injured at work. The employee did not notify the dentist that she had sustained an injury, was currently receiving medical treatment or that she was scheduled for upcoming surgery. To compound the situation, the employee had performance issues that were well documented in her personnel file. The employee had been counseled on several occasions regarding her attendance and arriving late for work. On this occasion, the employee failed to show up for her scheduled shift. The office manager called the employee to determine why she hadn’t arrived, but was unsuccessful in making contact with her. Later that day, the office received a fax from the office of an orthopedic surgeon advising that the employee would be off work for several months. Eventually, the office manager reached the employee, who stated that the communication from the orthopedic surgeon stemmed from a back injury she sustained at work. The office manager and the dentist were shocked by the employee’s assertion that she sustained a workplace injury, as she had not earlier provided any notice to the office. The office followed normal protocol in assisting the employee to file a claim for workers’ compensation benefits. While the office attempted unsuccessfully to obtain more information regarding the employee’s medical leave, the employee did send multiple text messages stating that she was unable to return and needed to extend her leave. The employee’s absence created a strain on overall office operations, and the office ultimately decided to terminate her employment.
In California, even if an employee is terminated due to personnel issues, their workers’ compensation claim can continue.TDIC’s Risk Management analyst recommended that the office consult with an employment attorney for advice on how to proceed.
If facing a similar scenario, TDIC recommends the following:
- Immediately notify your carrier of an injury involving an employee to begin the process of filing a workers’ compensation claim.
- While workers’ compensation laws vary from state to state, most states generally require employers to provide a workers’ compensation claim form to the employee within one working day after becoming aware of the work-related injury or illness. In California, for example, once you have knowledge of the injury, you have 24 hours to provide your employee with a DWC-1 claim form. Additional information on state-specific workers’ compensation laws are available on the U.S. Department of Labor’s website.
- Continue to engage with your employee throughout their leave and attempt to check in with the employee every 30 to 45 days to obtain a work status report. The employee should also advise you of the date they expect to return to work. If the employee is not communicating with your office, document your attempts in the employee’s file.
Scenario 2: Filing a Workers’ Compensation Claim after Termination
A morning huddle at an office didn’t begin well and actually ended with two employees arguing about a patient scheduling error. One of the employees left immediately after the meeting without notifying anyone. The office manager attempted to contact the employee, but the employee refused to speak to her and simply hung up. The employee did not return to work or notify the office for the remainder of the week. The following week, the office sent the employee a letter recounting her actions and informed her that they were therefore accepting her resignation. Several weeks later, the employer received a letter from a workers’ compensation attorney representing the ex-employee. The letter advised that the employee was filing a cumulative trauma claim related to pain in her neck, shoulders and thigh, as well as mental stress.
If facing a similar scenario, TDIC recommends the following:
- Engage in required discussion with an injured employee and obtain medical work status reports and assist with the employee’s return to work. However, know that this not required once the injured worker is no longer your employee.
- Notify your carrier of an injury involving an employee to begin the process of filing a workers’ compensation claim.
- Know that in California if an employee was terminated and is represented by an attorney, the assigned workers’ compensation adjuster will ensure that the employee is treated by a physician in the medical provider network (MPN). As an employer, you do not need to authorize treatment for the employee.
- Continue to cooperate with the insurer and third-party administrator during the investigation of a claim, such as providing a copy of the employee’s personnel file and statements to the defense attorney. All evidence will be used to provide the defense of the claim.
Every claim is unique and based on the specific facts and events leading up to the employee’s workplace injury. After filing a workers’ compensation claim, be sure to stay in contact with your carrier so you may better understand regulations, processes and your role as an employer.
- Be familiar with employer-required postings and employee notifications, as you are required to ensure your employees are aware of workers’ compensation and the benefits it may provide.
- Notify your carrier or third-party administrator within 24 hours of your notification of the work-related injury so a claim can be set up immediately.
- Provide the state-required forms to your employee after first notice of injury.
- Contact your carrier to determine where you can send your employee for their first medical visit and subsequent care. In the event your employee needs immediate medical care, do not hesitate to call 911 or send the employee to the nearest emergency room.
- Do not treat employees who file workers’ compensation claims (and those returning to work after an injury or claim) differently than other employees. This will eliminate the potential for an allegation of discrimination based upon filing a workers’ compensation claim.
- Engage in an interactive discussion with your employee to determine if you can accommodate temporary work restrictions and provide transitional work (light duty) while the employee heals from the injury. Document your discussions in writing, as the notes could be used as part of the claim process and determination of benefits.
TDIC can provide guidance specific to your situation. You may be referred to an employment attorney for matters dealing with personnel issues and termination. If your employee seeks legal representation, your workers’ compensation carrier should obtain a workers’ compensation attorney to defend your case. If you have questions about your policy or coverage options, contact your carrier directly.
TDIC’s Risk Management Advice Line is a benefit to TDIC policyholders. To schedule a confidential consultation with an experienced risk management analyst, visit tdicinsurance.com/RMconsult or call 800.733.0633.