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P.O. Box 1750, Cockysville, MD, 21030
Workplace Safety Bulletin
Workers' Compensation For Horseplay Injuries
Workers’ Compensation generally covers any injury or illness you incur on the job. However, if you decide to engage in horseplay and are injured while you goof off, you need to know if your Workers’ Compensation coverage will pay for your injury treatment.
Legal Definition of Horseplay
The term horseplay encompasses any activity that’s considered roughhousing, goofing off or playing.
Know Your Employer’s Horseplay Guidelines
You may want to engage in horseplay to take a break, relieve stress, build rapport, or play a harmless prank. However, many employers discourage horseplay because it can result in employee injuries or damaged property, and it’s unprofessional. In this case, a horseplay injury will probably not be covered by Workers’ Compensation.
Alternatively, your employer may encourage horseplay as part of your workday activities. Your employer may even accept or contribute to such playful behavior. These factors, along with the seriousness and duration of the horseplay, may allow you to file a claim and successfully receive Workers’ Compensation for an injury you sustain as you play.
Read your employee handbook to verify whether or not your Workers’ Compensation coverage extends to horseplay injuries.
What if You’re a Horseplay Victim?
Your co-workers may engage in horseplay and accidentally injure you. Because you’re an innocent bystander, you could file a Workers’ Compensation claim. The insurance company will generally pay the claim because you were not involved in the playful act.
Examples of Workers’ Compensation Claims Involving Horseplay
Consider several outcomes of employees who filed Workers’ Compensation claims for horseplay.
A construction worker shook his butt at a co-worker, who playfully backed up the truck and tried to hit the worker with the truck's mirror. Instead, the co-worker hit his friend with the bed of the truck. Because the men were engaged in unnecessary horseplay, the Workers’ Compensation claim was denied.
In fun, a restaurant worker kicked his leg into the air. He slipped on the wet floor and injured his leg and groin. The court ruled that the action was not horseplay because the incident lasted only a few seconds and was acceptable behavior for employees at that restaurant. Therefore, the man could file a Workers’ Compensation claim.
An employee used crutches because of a knee injury. After a co-worker playfully tried to trip him, the man re-injured his knee. He successfully received Workers’ Compensation because he did not instigate the horseplay.
Before you decide to engage in horseplay at work, consider the consequences. You could be injured and unable to file a Workers’ Compensation claim. For more information, check your employee handbook or talk to your supervisor or HR director.
HMS Insurance Associates, Inc.
Understand The Jones Act And Maritime Injury Claims
Seamen who suffer an injury on the job are protected by the Jones Act. Also called the Merchant Marine Act of 1920, these laws include many components that support safe working conditions for employees in the vibrant maritime industry.
Who Does the Jones Act Protect?
According to the Act, seamen have the right to work in a safe environment. They may file a civil suit and maritime injury claim if they are the victim of an accident or injury on the job.
The act covers all seamen who work aboard or support the function of a maritime vessel on navigable waters. The seamen must spend at least 30 percent of their workday on the vessel to be protected by the Jones Act.
Why is the Jones Act Important?
The Jones Act makes vessels safer for seamen as it forces vessels to follow U.S. laws and holds employers responsible for their employees' safety. It supports the United States military as it ensures private vessels are safe and ready to function properly before, during and after war time. It also ensures the safety and productivity of seamen on the nearly 40,000 vessels that support the country's economy.
Potential Jones Act Claims
Every Jones Act claim is treated individually, and damages depend on the individual situation and details. Seamen may claim several things when they file a Jones Act claim.
- Receive payment for present lost wages, a portion of future earnings and losses of vacation time, pensions, 401k contributions and other benefits.
- Receive payment for present and future medical expenses related to the accident or injury. These claims can include:
Mental health care
Occupational or physical therapy
Transportation to treatment
- Receive payment for medical costs, lost wages or pain and suffering from accidents and injuries caused by an unseaworthy vessel or employer negligence.
- Receive payment to cover the funeral or lost wages and special needs of the seaman's dependent children if the seaman dies while on duty.
Pain and Suffering
- Receive payment for mental and physical pain suffered.
How to File a Jones Act Claim
When a qualified seaman is injured on the job, he or she may file a claim for damages. By law, the claim must be filed within seven days of the injury. It should also be reported to the Captain or supervisor, and an official maritime accident report detailing the injury or accident is required.
The Jones Act allows seamen to file maritime injury claims. It protects seamen and is important for the Americans they protect and support.
HMS Insurance Associates, Inc.
Does Workers' Compensation Cover Prescription Medications?
When your doctor prescribes medication for a routine concern, you expect the pharmacy to fill the prescription. You also rely on your insurance company to cover at least a portion of the cost.
What happens, though, when you need medicine to treat an illness or injury related to a Workers’ Compensation claim? Workers’ Compensation procedures vary slightly in every state, but here’s the general process you’ll undergo as you get your prescription medications filled during your treatment a Workers’ Compensation illness or injury.
Follow Workers’ Compensation Filing Protocols
You generally have to file a Workers’ Compensation claim within 30 days of the illness or injury. Follow the correct reporting and filing procedure to improve your chances of getting all your treatment, including medicine, covered.
Then, visit an approved doctor and complete all recommended treatment. Your employer will provide you with a copy of the participating doctors you may visit for your Workers’ Compensation claim treatment. You risk paying out-of-pocket for your treatment and medicine if you fail to comply with these protocols.
The Workers’ Compensation Process for Medication Prescriptions
Workers’ Compensation in many states covers all prescribed and over-the-counter medications your doctor recommends during the first seven days after your reported illness or injury. That means you can begin to address any pain and other symptoms right away.
Any medication requests your Workers’ Compensation doctor submits after the first seven days must go through several channels. In most cases, you won’t receive a prescription you can fill right away. Those general steps include:
You visit your doctor, and he or she recommends medicine that will treat your illness or injury.
The doctor records the medication in the Workers’ Compensation paperwork and submits the request to the Workers’ Compensation insurance carrier.
A third-party administrator will review your medical record to ensure the medication prescribed is necessary and essential for your recovery.
The insurance adjuster or case manager will authorize or decline the prescription. In general, ongoing prescriptions are approved. The adjuster may need to see a Letter of Medical Necessity from the doctor before approving new prescriptions.
A Nurse Case Manager may provide ongoing review of your Workers’ Compensation medical records and prescriptions, particularly if you take opiates or have been prescribed other medication for longer than six months.
Workers’ Compensation benefits allow you to visit a doctor and receive the treatment you need, including prescription medications, for an illness or injury. Understand how the process works as you access the medicine that supports your recovery and prepares you to return to work. If you need help understanding your benefits, review your Workers’ Compensation benefits package or talk to your employer.
HMS Insurance Associates, Inc.
Workers' Compensation for Water Sport Businesses
Owning a water sport business can be fun and a good investment, but you need to hire employees to help the business run smoothly. Be sure you purchase adequate Workers' Compensation to cover your employees and protect your assets.
Covered Water Sport Businesses
Your water sports business could encompass dozens of activities in, on or near water. Whether you offer one or several sports, you will need Workers' Compensation for your business. Example of water sports offerings include:
Boating, Sailing, Yachting
Kayaking, Tubing, Canoeing
White Water Rafting
Jet or Water Skiing
Hoverboarding, Flyboarding, Wakeboarding
Paddleboarding, Paddle Surfing
Snorkeling or Scuba Diving
Swimming and Diving
What is Workers' Compensation?
Many states require business owners to purchase Workers' Compensation for employees, including seasonal and temporary workers. It pays certain expenses employees incur if they are injured or suffer an illness while performing work-related tasks.
Workers' Compensation benefits can pay for:
Every Workers' Compensation insurance policy has two parts.
Part One or Coverage A
addresses your statutory liability, meaning the coverage your state requires you to carry. It includes no coverage limits and will pay all claims regardless of any benefit changes your state makes.
Part Two addresses employer liability
for any employees that are exempt from Worker's Compensation coverage. These employees could include independent contractors like boat owners or dive instructors who do not purchase their own Worker's Compensation policy. Part Two can also cover legal expenses from third-party lawsuits.
Why you Need Workers' Compensation for Your Water Sport Business
Whether your business operates year-round or seasonally, you value your employees and want to protect them from injuries or illnesses. However, accidents happen. You will want to provide financial resources that help your employees navigate their recovery and return to full health and work as quickly as possible.
Adequate Workers' Compensation protects your business, too. It can protect your assets if you are sued by an employee, and it can pay legal expenses related to any lawsuits. Workers' Compensation coverage also protects you from fines levied by your state if you don't purchase adequate coverage.
Contact Your Insurance Agent
For more information on Workers' Compensation for your specific water sport businesses, contact your insurance agent. He or she will assist you in understanding and complying with your state's Workers' Compensation laws. Your agent will also help you purchase the policy that's right for your business and needs.
With the right Workers' Compensation policy, you receive peace of mind. It protects your employees and your assets as you help your customers have fun while playing on the water.
HMS Insurance Associates, Inc.
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