We asked our claims representatives what questions they typically hear from employers who are managing employees with workers’ compensation claims. Here are a few common questions, and the answers:

How do we manage performance issues when an employee has an active workers’ compensation claim?

When an injured employee isn’t performing the duties of their job up to your standards, the first thing you need to ask yourself is whether the substandard performance is related to the work injury.

If it is related, you may need to review the tasks assigned and confirm they fall within the employee’s medical restrictions. Your claims representative and rehab professional (if one is working with the employee) can assist with this process.

If it is unrelated to the injury, the next thing you need to ask yourself is how other employees are treated when similar performance issues arise. All employees should be treated the same, including the injured employee.

After you’ve decided what you’re going to do, act promptly because your silence implies approval and condones the performance. If the performance concerns are not addressed right away, but you later bring up the issue as a reason for discipline or termination, the employee could claim the issue is simply a “pretext” and that the real reason for the discipline is the work injury. Employees cannot be disciplined for suffering a work injury.

Lastly, be sure that you thoroughly document any performance concerns and disciplinary action. If you do feel you need to terminate an employee who has suffered a work injury, we’d recommend discussing it with your claims representative and your employment law attorney. They can walk you through the potential workers’ compensation implications of terminating, and whether there may be a basis for an employment law claim.

How do we handle the employee’s health insurance premiums while they are off work due to a work injury?

This differs by state. For example, in Minnesota, the law prohibits terminating group insurance for an employee who is absent due to becoming totally disabled.

Talk with your employment law attorney to make sure you’re aware of any relevant laws and rules. Workers’ compensation wage loss benefits do not include health insurance premium withholding.

How do we maintain a good relationship with an employee who is off work due to a work injury?

The most important thing you can do after an injury is to stay in regular contact with the injured employee. Call or text the employee right away, and keep in touch.

First and foremost, let the employee know you care about them and want to see them recover. Send a card or small “get well” gift if appropriate.

Another thing you can do is to make sure the employee knows that you will provide any needed accommodations so that they can return to work as soon as they’ve healed enough to come back. Injured employees who are off work often worry that they won’t have a job to return to, and this will help alleviate those concerns.

If you ever have a question about managing a claim, don’t hesitate to reach out to your SFM claims representative for help.

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

Sometimes during the course of treatment for a work injury, a claims representative will decide to request an independent opinion from another physician.

This can help in making determinations such as whether:

• The injury is work-related
• The employee could go back to work without or with fewer medical restrictions
• The employee is getting the right medical treatment
• The employee needs surgery

For example, an employee has already undergone two unsuccessful back surgeries and requests a third one, or an employee with arthritis claims that work aggravated the condition, causing the need for a total knee replacement.

In cases like these, a workers’ compensation insurer might pay an independent doctor to review the employee’s medical history, conduct a physical exam and give an opinion that can be used in a hearing. These are referred to as “independent medical examinations” in most states. There are states that don’t have independent exams, however, such as Iowa where employers choose the treating doctor.

Here are a few things you should know about independent medical examinations:

• Timing is everything
  If we arrange for the examination too soon, the doctor might conclude that more time is needed to determine whether the present course of treatment is working. This typically isn’t a desired outcome, since usually one goal of requesting the independent examination is to gain support for a change in the course of treatment.
• They’re expensive
  One examination can cost from $2,000-$12,000. For some injuries, examinations by multiple specialists might be necessary. For example, a head injury might require examinations from a neurologist, ophthalmologist, psychiatrist and other specialists.
• The conclusion isn’t always favorable
  Of course, when requesting an independent medical examination, the claims representative is hoping it supports the employer’s case, but it’s not uncommon for the results to come back otherwise. Even though the insurance company is paying for the examination, it’s understood that the doctor is to give an honest opinion.
• They’re not final
  Even if the doctor’s opinion seems favorable, it’s only one factor that will be considered by the judge in a litigated workers’ compensation claim. The judge will also consider the treating doctor’s opinion, any other medical opinions the employee has sought out, and the employee’s own statements.
• Choice of doctor is critical
  A judge can decide to throw out the results of an independent medical examination entirely if he or she believes an opposing opinion, such as that of the treating doctor, is more credible. Because of this, it’s important to choose a high-quality doctor who will provide a credible opinion backed up by the facts of the claim.
• They’re perceived as adversarial by employees
  If an employee hasn’t yet retained an attorney, a request for an independent medical examination may compel the employee to do so. If the independent examination recommendations are counter to how the employee has been comfortable being treated, the likelihood of getting an attorney involved increases.
• They’re not the only option
  There are other ways to learn more about an employee’s medical condition, such as writing a letter to the treating doctor, or asking that the employee get a second opinion from a doctor of his or her choice. Another option in some states, including Minnesota, is to get a neutral evaluation in which the judge chooses a doctor to do the examination.

There is a lot to consider when requesting an independent medical examination, and SFM has doctors and attorneys on staff who provide advice when claims reach this point. Independent medical examinations typically aren’t necessary, but they can be useful tools.

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