Every now and again an owner will ask me…if my employee has a small cut or injury should I go ahead and pay the claim versus turning it over to my insurance carrier?

It never fails. It is a great question and one that should be asked.

My response is always the same. Yes, report it. Report all workers comp claims to your insurance carrier.

Every owner is concerned about their experience mod aka EMR being affected. NCCI, the governing body that sets loss costs each year and factors such as the primary and excess figures provides a healthy discount to incite reporting of claims. If the claim is medical only the amount paid is discounted at 70%. Example being, if your employee cuts his hand and you send him or her to Urgent Care; the bill is $100. You report that to your insurance carrier and $30 is entered into the formula for the EMR not $100. That is reason number one to report all claims. Reason number two would be what I call “first to pay” situation. Take that same employee with the cut hand. If you paid out of pocket the medical bills and a month later that employee’s hand becomes infected resulting in serious medical attention or even surgery you the employer could be on the hook. Always, in my opinion have the insurance carrier make first payment on a workers comp claim. You can always work with that carrier on wage payments if the employee cannot return to work right away.

 

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