No one starts out their day expecting a work injury.

On-the-job injuries are unanticipated, urgent and unfortunate for everyone involved, but there are best practices you can follow to make a bad situation better for you and your injured employee.

When to report work injuries

One key step is to report any work injury as soon as you can. Reporting immediately helps workers’ compensation claims go more smoothly for a number of reasons, including:

• Employees get any needed care right away
• Workers’ compensation benefits are paid promptly
• The carrier has time to review and submit the injury to the state

To make this happen, employees and their supervisors must be trained to identify work injuries and report them immediately. If a supervisor sees an injury occur, or hears about it in another way, in many states the employer is required to report the injury. This is true even if an employee does not formally report a work injury, in most states. In South Dakota, employees are required to report injuries to their employers within a specified time period.

We recommend reporting all work injuries, even if they are so minor they do not require medical attention. This way if the injury worsens over time and does lead to a doctor visit or time off, you will have captured information needed to manage the claim.

Reporting incident-only work injuries (injuries which do not lead to medical or lost-time expenses) does not impact your experience modification factor (e-mod).

How to report work injuries

When you’re ready to report an injury to SFM you have a number of options, but the two most common methods are by phone and online.

You can call the SFM Work Injury Hotline anytime at (855) 675-3501 to report work injuries. Here are a few tips for reporting via the hotline:

• We now offer a streamlined report-only option during business hours (7 a.m. – 4 p.m., M-F) for situations where the employee does not need to speak with a nurse. We recommend choosing the nurse option when the employee is unsure whether to seek medical treatment. (Calls outside of normal business hours will automatically go to a nurse.)
• If a supervisor is not available, an employee can call the SFM Work Injury Hotline alone.
• If the employee has already received medical treatment or is not available for the call, we recommend choosing the report-only option (Option 1) during business hours.

You can also report online on our website (sfmic.com) anytime. You do not need to log in to report injuries online. You just need your policy number. This is a fast and easy choice. Many employers opt to report online in cases where the worker has already received medical care.

For more information on reporting injuries, visit sfmic.com/report and download a copy of our claim packet.

Understanding the injury

After a work injury occurs, it’s important to figure out what happened and what you can do to prevent similar injuries in the future.

You can analyze a work injury in four steps:

• Collect data: Talk to witnesses, take pictures and review maintenance and training records.
• Identify the causes: Determine whether equipment, risky behavior, inadequate training, lack of personal protective equipment, the work environment, or other factors were to blame in causing the injury.
• Analyze the findings: Examine all the facts and distinguish between the immediate causes (such as a broken ladder rung) and underlying causes (such as lack of training).
• Develop a plan: Identify the steps to prevent similar injuries in the future.

For more information on accident analysis and a worksheet to guide you through the process, download our Accident analysis CompTalk from the resource catalog on sfmic.com.

Return to work 

When employees are off work due to on-the-job injuries, it’s important to show concern right away and stay in contact until the employee returns to work. When employers don’t reach out, employees can feel isolated and worry that they will not have a job to return to.

We recommend bringing employees back to work as soon as possible, even if you have to modify their regular job or provide light-duty work to accommodate medical restrictions. Bringing employees back to work as soon as you can helps them:

• Recover faster
• Stay in the routine of working
• Feel productive
• Maintain workplace relationships

This also helps keep wage-loss benefits down, which helps limit the impact of the injury on your future workers’ compensation premiums.

Work injuries are better prevented, but when they do occur, your SFM team is here to help. Your claims representative is always available to guide you through the process and answer any questions. You can also find more resources in the Employers section of sfmic.com.

When an employee is injured, these resources can help

• Work injury claim packet
• Report an injury page
• Your SFM claims representative
• Claim Connection portal for injured workers

Are undocumented workers eligible for workers’ compensation benefits? It varies from state to state.

Undocumented worker rules in Minnesota

In Minnesota, undocumented workers are covered by workers’ compensation policies. According to Minnesota Statute, “aliens” are considered employees and are therefore eligible to receive benefits for work-related injuries.

This was first declared by a Minnesota Workers’ Compensation Court of Appeals case in 1999, the Gonzalez v. Midwest Staffing Case , which decided that undocumented workers are entitled to wage-loss benefits, even if they used false paperwork to get hired.

The specifics of undocumented workers’ eligibility for benefits have since then been more clearly defined. In the case of Rivas v. Car Wash Partners , an undocumented worker was injured and lost time from work. The employer offered a post-injury job, but only if the worker could provide proof that he was authorized to work in the U.S. Since the worker couldn’t offer legal documentation, he wasn’t able to return to work at the company, so the employer was able to stop paying wage-loss benefits.

Significant impact on your premium

Cases like this can have a significant impact on your workers’ compensation premium. Injured employees are entitled to receive benefits until maximum medical improvement or 130 weeks of benefits have been reached. Hiring smart can help prevent this from happening to you.

Rules in other states

Undocumented workers’ eligibility for workers’ compensation coverage can vary from state to state. If you’re not sure of your state’s laws, check with your insurance carrier.

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

One factor that determines your workers’ compensation premium is your loss history. This means that having a workers’ compensation claim can cause future premiums to increase.

Impact for larger organizations

At a larger organization, past claim costs are used to determine your experience modification factor (e-mod), a multiplier used to calculate your premium. If your claim costs are lower than average when compared with other organizations of similar type and size, then your e-mod will be lower than 1. That means it will reduce your workers’ compensation premium. On the other hand, if your claim costs are higher than average, your e-mod will be over 1. That will increase your premium.

The e-mod takes into account three years of loss history not including the most recent policy year, so that’s how long any given claim may affect your premium.

Impact for smaller organizations

If your premium is low enough (generally below $3,000 to $7,000 depending on the state), you may not be assigned an experience modification factor (e-mod). If you don’t have an e-mod, the workers’ comp underwriter will look at your loss history and use that information to decide whether your business is a risk he or she is comfortable writing. In some cases, an underwriter might be able to increase or decrease your premium based on loss history. This depends on state law and the insurance company’s underwriting standards.

Minimize the impact of claims by bringing employees back to work

One key thing you can do to minimize the impact of claims on your premium is bring employees back to work as soon as they are medically able. You could modify the employee’s job, offer reduced hours or offer a light-duty job until the employee is fully healed. For example, if you have a painter with an arm injury, he or she could answer phones or prepare estimates.

To save the most on future premiums, bring injured employees back to work before your state’s waiting period has kicked in if possible. (This is three to seven days depending on your state.) If you do this, the claim will be considered medical-only, so only 30 percent of the claim costs will be included in the e-mod calculation.

In addition to the cost savings, bringing employees back to work as soon as possible helps employees maintain their mental and emotional well-being, and improve their financial stability. It’s not only the smart thing to do, but also the right thing to do.

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

There’s one way to boost the chances injured employees will thrive in recovery that most employers don’t think of — building relationships with the local doctors most likely to treat your injured workers.

This lays the foundation for teamwork between you, the physician and your insurer to bring injured employees back to full health and productivity. It also helps stave off the alternative — an adversarial relationship where the injured employee feels stuck in the middle.

Even if workplace injuries are rare in your organization, there’s value in getting to know local medical providers. Even one contentious claim can cost your organization considerable time and money.

Why build a relationship with a medical provider?

When an employee is injured, their physician decides if, when and under what conditions the employee can return to work.

It’s a critical decision because studies show that the longer an injured employee is off work, the less likely it becomes that he or she will ever return. On the other hand, early return to work keeps employees active and engaged, helping them maintain psychological well-being.

But when doctors have limited knowledge of an injured employee’s working conditions, they may keep employees off work longer than necessary.

For example, a physician might keep an employee off work unnecessarily if the doctor:

• Doesn’t know you offer transitional, light-duty work
• Is uncertain about whether the employee will be safe from reinjury
• Doesn’t know who to call to get questions answered

All of these issues can be solved by helping the physician get to know you and your organization.

What does partnering with a physician look like?

In an ideal scenario, an injured worker’s employer, medical provider and work comp insurer work together to bring the employee back to health and productivity as swiftly as possible.

Team members trust each other and hold one another accountable to do what’s best for the injured employee.

Take the example of a school janitor who hurts his back and won’t be able to do any heavy lifting for at least a few weeks.

Because the physician knows the school will accommodate work restrictions and trusts that the janitor won’t be given work that could cause re-injury, she allows him to return to work with restrictions that include:

• Limiting lifting to 20 pounds maximum
• Avoiding bending at the waist
• Avoiding pushing, pulling and squatting

Seeing this, the school puts the janitor to work doing lighter custodial duties such as dusting and dry mopping.

Had the doctor questioned whether the school would accommodate such a restriction, she might have chosen to keep him off work for weeks until his back was completely healed. This could have led the claims representative to question the doctor, with the injured employee not knowing who to believe.

Having a face-to-face relationship with a medical provider can make workers’ compensation claims less disruptive and lead to better outcomes for injured employees.

When everyone’s working together as a team, injured employees don’t have to feel like they are being pulled in different directions. Communication is open and clear, so injured employees don’t feel like people are talking behind their backs. On the contrary, employees feel important and cared for knowing that there’s a team of people working to help ensure recovery.

How to connect with a local provider

Building a relationship with a local physician is as simple as calling a nearby clinic and requesting a meeting.

Look for a physician who is board certified in occupational and environmental medicine. If no specialist is available in your area, find a clinic with staff experienced in treating work injuries. In some cases, this may be a physician assistant, nurse practitioner or chiropractor.

You should know that while the laws in some states, such as Iowa, allow the employer to choose the initial medical provider, many don’t. If your state does not, you can only suggest that injured employees go to your preferred provider, and employees have the right to choose where to seek medical treatment. Because of this, you’ll want to build relationships with the physicians where employees are most likely to treat.

When you meet with providers, let them know:

• The types of work employees at your company perform (if they can’t tour your facility, bring a video of the workplace to show them)
• That your company offers transitional, light-duty work to accommodate work restrictions and is committed to return to work
• That you care about your employees’ well-being and are committed to helping injured employees recover
• Ensure that the provider seems like a good fit for your organization, and shares your commitment to return-to-work programs

Other questions you may want to ask include:

• Do you treat the injured employees of other organizations?
• What would you need from us in the event of an injury? For example, would you need the injured worker’s job description or a statement notifying you that we accommodate transitional, light-duty work whenever possible?
• How would we schedule an initial visit for an employee who is new to your clinic?
• What types of injuries are you willing to handle on a rush basis to avoid unnecessary trips to the emergency room?
• What are your hours of operation, and where would you refer patients after hours?

If an employee is injured, here’s what you can do to help the treating physician and open the lines of communication:

• Call the clinic to let them know that an injured employee is heading there and remind them that you offer light-duty work
• Send along a Work ability/return-to-work form with every appointment
• If you’re able, send along a list of light-duty jobs at your organization that might be appropriate given the employee’s condition
• Provide contact information so they can easily reach you if needed

Having a face-to-face relationship with a medical provider can make workers’ compensation claims less disruptive and, more importantly, lead to better outcomes for injured employees. Consider taking the time now to reach out to one or more providers in your area.

For more details on this topic, see our Medical providers CompTalk.

Originally published in May 2018; updated August 2024.

Policyholders should remember to report claims as soon as possible to avoid potential penalties from state labor departments.

Often, states will assess penalties for what are generally called “late first action,” a late payment or a late denial of benefits.

“The earlier you report a claim to us, the more time we have to address it,” said Angie Andresen, Vice President of Claims at SFM. “Employers should report claims as soon as they know about it — even if there’s no lost time or medical treatment. Plus, if the claim does turn into something more, we can start handling it immediately.”

If it is deemed that it was the employer’s fault for a late first action, the policyholder will bear the responsibility for the penalty, which, in some states, starts at $3,000 and can increase based on the situation.

The key takeaway? Report claims as soon as possible and keep an open line of communication with your representative.

If you have questions, reach out to SFM.

Did you know that the longer an employee is off work due to an on-the-job injury, the less likely it becomes that the employee will ever return to work?

That’s why employers and injured workers benefit from strong return-to-work programs.

Even if injured employees can’t return to their regular jobs right away, bringing them back as soon as possible by providing modified-duty tasks or reduced hours helps them:

• Recover faster
• Stay in the routine of working
• Feel productive
• Maintain workplace relationships

Employers also benefit by bringing injured employees back to work as soon as they’re medically able. Having employees back at work, even part-time or in a different role, can:

• Reduce the likelihood of litigation
• Help control workers’ compensation claim costs, which affect future premiums

Past workers’ compensation claims affect future premiums

You probably know that your loss history is taken into account when calculating your workers’ compensation premium, but you may not know exactly how it works.

Your state’s workers’ compensation data collection organization calculates an experience modification factor (e-mod) for each employer that meets state-specific qualification requirements.

If your loss history is average for your class and size of business, your e-mod will be 1.00. If it’s better than average, it will be less than one. Because your e-mod is used as a multiplier when calculating your premium, a better-than-average e-mod will generally lower your premium.

For more details on this process, see our CompTalk on e-mods and read our blog, How your workers’ compensation e-mod is calculated.

Preventing lost-time claims pays off

When calculating an e-mod, not all claim costs are treated equally.

If a claim remains medical-only, meaning the injured worker does not receive wage-replacement (also called lost-time) benefits, claim costs are discounted by 70 percent.

To keep a claim medical-only, you must bring the employee back to work before your state’s waiting period ends. For example, waiting periods in these states are:

• Three days in Iowa, Minnesota and Wisconsin
• Seven days in Nebraska, Kansas, South Dakota, Indiana and Tennessee

Split-point increases make return-to-work more important

The split point — used in the e-mod formula for workers’ compensation — is the dollar level at which each claim is divided into two parts:

• Primary (the cost of each claim incurred below the split point)
• Excess (the cost of each claim incurred above the split point)

When total costs for an individual claim rise above a split point that’s set by each state annually, those costs are also discounted for the purposes of calculating your e-mod.

The split point ranges from $17,500 to $29,500 in the states of Minnesota, Wisconsin, Iowa, Nebraska, Kansas and South Dakota.

Example: How return-to-work impacts future premium

If you can bring an employee back to work before the waiting period ends, the impact of the claim on your e-mod and future workers’ compensation premiums will be significantly less.

Here’s an example:

Consider two assisted living facilities, each with about a dozen employees and currently paying about $23,000 in workers’ compensation premium.

A certified nursing assistant at the first facility slips and falls while working. Her medical bills total $7,500, but she is able to start doing light-duty work filing and answering phones before the state’s waiting period ends, so the claim remains medical-only.

At the second facility, another nursing assistant has a similar accident, but her employer does not provide light-duty work, and she ends up receiving some workers’ compensation benefits for lost pay. The combined cost for her medical expenses and lost-time compensation total $7,500.

Although the total cost for both claims is the same, the impact on their respective workers’ compensation costs are very different — only 30 percent of the medical-only claim impacts the employer’s e-mod, compared with 100 percent of the lost-time claim.

What does this mean for these employers’ work comp premiums? The claim that remained medical-only would cost the employer $2,850 over three years in terms of increased premium. In comparison, the lost-time claim would cost the employer $9,494 over three years.

How to start a return-to-work program

If you don’t have a return-to-work program already, follow these four steps to start one:

1. Draft your policy

Formally state that your company intends to bring injured employees back to work as soon as they’re medically able, and will provide adaptations or light-duty work when needed. For guidance, see SFM’s sample return-to-work program.

2. Appoint a claims coordinator

This is an individual tasked with overseeing workers’ compensation claims and return to work. Have this person develop a plan for reporting injuries and communicate it to supervisors and employees.

Having step-by-step instruction sheets around also helps the process. For more details, see SFM’s CompTalk on claims coordinator duties.

3. Select a primary care clinic

Establish a good working relationship with a local clinic where the physicians understand occupational medicine and return-to-work.

If possible, meet with doctors at your preferred clinic to give them an overview of your organization and tell them you are committed to returning employees to work as soon as they are medically able. Suggest that your employees go there if they’re injured.

Note that in most states, employees have the right to choose where to have their injuries treated.

4. Identify transitional jobs

Transitional or modified-duty jobs provide opportunities for your employees to return to work even when medical restrictions prevent them from doing their regular jobs.

That might mean having an injured employee work in a different department temporarily.

To come up with ideas ask your managers, “What would you do if you had an extra pair of hands?” For more ideas, check out our lists of transitional jobs broken down by industry.

See our infographic on return-to-work below:

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices. Originally posted in February 2021; updated in May 2024.

When dealing with small medical bills, you may think that covering it yourself rather than submitting it to your workers’ compensation insurer will be easier and less costly.

While this seems logical, choosing to pay a medical bill yourself can create a ripple effect of future problems.

In many states, unless your business is self-insured, paying a claim rather than reporting it to your workers’ compensation insurer may be illegal. It’s could also be a violation of your contract with your insurer because it can artificially lower your experience modification factor (e-mod) and premium.

Other reasons why an employer may not want to pay might also include:

• It could be held as an admission of liability for an injury or admission of an injury
• In most states, an employee cannot waive the statutory right to work comp benefits

Of course, as is the case with most employment laws, they vary by jurisdiction. Here are a few examples.

Minnesota

The Minnesota Department of Labor and Industry explains why employers should not pay medical bills in its training guide for employers .

“If an employer does not report an injury to its insurance company, it could become a more expensive workers’ compensation claim. The workers’ compensation law is complicated. It has many requirements, such as deadlines for payment, forms that must be filed, determining what medical treatment is reasonable and paying bills according to medical fee schedules. Workers’ compensation insurers are required to know how to comply with these requirements. Penalties may be imposed if the claim is handled inappropriately. If the error leading to a penalty was the fault of the employer, the insurer may pass that cost on to the employer. The employer may jeopardize the ability to adequately defend the claim or opportunities to minimize losses if the insurer does not have immediate knowledge of the injury.”

However, exceptions may be allowed under a large deductible policy or if it is a self-insured person with approval from the state department of commerce to directly manage and pay work comp claims.

Wisconsin

In Wisconsin, employers can pay work comp bills, but there are limited circumstances when they can pay.

There is also an exception for the self-insured in Wisconsin.

South Dakota

It is not illegal to pay such expenses in South Dakota.

And employers should note that if they do not carry work comp coverage they can be sued civilly.

Again, there is an exception for the self-insured.

Iowa

Likewise, Iowa allows employers to pay medical bills. An employer has the right to choose the medical care/medical provider, meaning an employer would have the right to pay.

There are other factors to consider for the self-insured, and criminal and civil penalties could be levied against employers that violate the mandatory insurance law.

Nebraska

In Nebraska, it is illegal for employers to pay medical bills for injured workers.

Exceptions may be made under a large-deductible policy, but it still requires the insurer to pay with reimbursement to the employer or is self-insured with approval by Nebraska courts.

Kansas

Kansas also allows employers to pay these bills.

If an employer is insured for work comp, by law the insurance carrier is responsible for paying.

In the limited circumstances where an employer does not have to carry workers’ compensation insurance, uninsured employers subject to work comp laws are responsible for the medical bills of covered employees. Also, an employer has the right to choose the treating physician.

In Kansas, an employer can be self-insured for workers’ compensation, but must demonstrate to the state the financial ability to pay any claims that might arise.

Missouri

Missouri allows employers to pay medical bills for their workers. But there are additional rules to note.

If an employee misses no time from work and all medical bills total less than $3,700, the employer may pay the bill. However, employers must notify their insurance carrier and the Missouri Division of Workers’ Compensation and is not included in the e-mod.

Tennessee

Lastly, Tennessee also allows employers to pay medical bills out of pocket.

Reasons not to pay out-of-pocket work comp costs

Beyond the legal obligations in many states, there are other reasons  employers should not make out-of-pocket payments for a workers’ compensation injury, including:

• Additional expenses; carriers often have pre-negotiated rates for care
• Should an injury become worse, and it wasn’t reported in a timely manner, a claim could be denied
• Doing so could impact your experience modification factor
• Potential cancellation of a policy

As noted above, it’s generally better to go through the proper channels when taking care of an injured employee.

Originally posted December 2017; updated February 2024.

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

Generally, motor vehicle accidents that occur when employees are traveling to and from the workplace are not covered by workers’ compensation.

However, there are two exceptions:

• If employees are required to bring their cars to the office for use during the workday, then travel to and from the office and business travel during the day are generally covered by workers’ compensation
• If you regularly provide transportation to and from the workplace in company-operated vehicles — such as buses, trucks or vanpools — injuries to employee passengers would be covered by workers’ compensation

Even if you’re unsure whether an automobile accident is covered by workers’ compensation, it’s always best to immediately report it to your work comp insurer.

If an employee is injured in a car crash, who pays medical bills? The auto insurance company or workers’ comp carrier?

If an employee is injured in a work-related car accident, workers’ compensation is the primary source of insurance for medical and wage-loss benefits.

This is why it’s important to report an incident to your workers’ compensation insurer right away if you have an employee who was injured in a work-related car accident.

What should employees do if they get into a car accident while driving for work?

If you have employees who drive for work, ask them to do the following if they are involved in an accident:

1. Call for help

Call an ambulance immediately if anyone is injured.

At the same time, even if there aren’t injuries, have employees call local law enforcement to the scene to file a police report and issue any citations. If this isn’t possible, make a legal accident report with the applicable police department as soon as possible.

2. Obtain key information

Find out:

• Names, addresses and phone numbers of witnesses and everyone in each vehicle
• License numbers and state registrations of all vehicles involved
• Insurance information from the other driver

3. Report it to you (their employer)

Immediately report the accident to the person in the organization who handles workers’ compensation claims.

What if the employee wasn’t at fault?

If the other driver was primarily at fault, it’s usually possible to recover workers’ compensation benefits paid from the negligent driver’s personal auto insurance carrier.

In many cases. SFM can recover 100 percent of the workers’ compensation benefits paid, but there are often situations that restrict us to recover only a portion of the total.

The reasons for this include:

• Some states have statutes that allow the employee’s personal injury attorney to take the first third of the settlement
• The other driver might not be 100 percent at fault, meaning the employee bears some responsibility
• Not all workers’ compensation benefits are recognized by auto insurers. For example, payments for rehabilitation services are often questioned by liability carriers because this is not a standard benefit paid under a liability claim in many states
• The driver’s auto insurance policy limits might be less than the amount of incurred workers’ compensation benefits

Make sure employees who drive for work know what to do if they’re involved in an accident

Hopefully, you and your employees won’t ever have to worry about dealing with a car crash, but it’s always best to be prepared.

Making sure your employees know what to do in the event of a crash can save you, and your employees, major hassles down the road.

Lastly, it is worth noting that educating employees who drive for work about safe-driving practices is always a good idea. Check out a few of our resources:

• Safe driving practices for employees
• Creating a policy for employee cell phone use while driving
• Eight tips for defensive driving
• Defensive driving: Supervisor Initiated Training tool

Originally posted June 2017; updated in February 2024.

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