Claims Talk with Karen McCarthy-Hawn


With the number of layoffs and furloughs occurring due to CoVid-19, employers need to stay in close contact with the Workers Compensation adjusters assigned to their claims. The employer needs to inform the adjusting staff of any employees that are currently on worker’s compensation that get laid off or furloughed. Adjusters need to ask the employees and employers if any unemployment claims have been filed or paid before reinstating temporary benefits. If an employee with an active workers compensation case is approved for the CoVid-19 Unemployment Benefits for any portion of their salary the adjuster will need to know this right away. There is normally a dollar for dollar offset in most states for unemployment compensation payments against temporary workers compensation indemnity payments.

The employer and carrier need to ensure that injured workers are not knowingly or unknowingly double dipping from the two benefit platforms. The carriers need to ensure they are not overpaying due to a lack of communication about the current work status or unemployment compensation payments being received especially in states that do not allow overpayment recoupments. If employees apply for Unemployment and are denied due to having open-active workers compensation claims that limited their ability to look for other gainful employment it is likely going to result in an entitlement to Temporary Partial Disability benefits. Of course, that is only if the employee is not barred for other administrative compliance reasons or defenses such as a prior self-limitations of their income including job abandonment or termination for cause. The employer may need to remind the handling adjuster of these defenses to ensure there is not an oversight. The reinstatement of benefits needs to be reviewed case by case by the employer, carrier, and defense attorneys assigned to ensure the employee is entitled to indemnity and is not overpaid.

RiskAware and Risk Transfer Insurance Agency are committed to providing the PEO Industry information necessary to assist in managing workers compensation insurance exposures of its customers.