Sample Workers Compensation Policy

Sample_Documents

DISCLAIMER: This is a sample template provided for informational purposes only. It does not constitute legal, tax, or financial advice. Organizations should consult their own legal and tax advisors and tailor this document to reflect their specific business needs, geographies, and applicable laws.

Document Type	Workers' Compensation Policy
Category	Benefits & Wellness
Company	<Company Name>
Version	v<Version Number>
Effective Date	<Effective Date: DD MMM YYYY>
Last Reviewed	<Date>
Next Scheduled Review	<Date> (every <12> months, or as required by law)
Policy Owner	Total Rewards, in partnership with Risk Management and Legal
Approver(s)	<Executive Sponsor Name/Title> and <Legal Department>
Contact	<Phone>

Purpose and Objectives

• Provide a consistent framework for statutory Workers' Compensation administration at <Company Name> across all applicable jurisdictions in <Country> and other countries where the company operates.
• Ensure prompt medical care, wage replacement, and legally required benefits for employees with work-related injuries or illnesses.
• Clarify roles, responsibilities, timelines, and documentation requirements for employees, managers, and the Total Rewards team.
• Reduce injury frequency and severity through safety practices and early, safe return-to-work.
• Comply with all applicable laws, including state, provincial, and national Workers' Compensation statutes, reporting, posting, and recordkeeping requirements.
• Establish data governance, audit controls, and vendor service expectations to safeguard employee privacy and company interests.

Scope and Applicability

In Scope

• All regular employees of <Company Name> in <Country> and any other jurisdiction with a statutory Workers' Compensation requirement where <Company Name> has a legal presence.
• Full-time, part-time, and fixed-term employees.
• Employees traveling for business on behalf of <Company Name> when in the course and scope of employment.
• Employees on approved light-duty or transitional assignments related to an accepted work injury.

May Be Covered Depending on Jurisdiction and Contractual Arrangements

• Temporary workers, interns, volunteers, and contractors may be covered by <Company Name> or by their agency/employer of record, as dictated by local law and agreements.
• Remote workers working from home; compensability depends on facts and applicable law.

Out of Scope

• Non-work-related illnesses or injuries.
• Independent contractors and vendors whose coverage is governed by their own employers, unless explicitly required by law or contract.
• International assignees when covered by separate expatriate insurance programs or by social insurance schemes specified in assignment letters.

Geographic Applicability

• This policy is intended to be adapted by jurisdiction (e.g., <State/Province>, <Country>). In any conflict between this policy and law, the law prevails.
• Add jurisdiction-specific addenda for <State/Province> and <Country> detailing waiting periods, maximums, and filing timelines.

Policy Statement

• <Company Name> maintains Workers' Compensation insurance or self-insured programs as required by law in each jurisdiction of operation. Coverage includes medical treatment, wage-loss benefits, permanent disability where applicable, vocational rehabilitation, and survivor benefits.
• <Company Name> supports early, safe return-to-work and provides transitional duty when feasible and consistent with medical restrictions and business needs.
• Employees must promptly report work-related injuries and illnesses. Managers must support timely reporting and ensure immediate actions for safety and care.
• Fraud, misrepresentation, or abuse of this policy may result in disciplinary action up to and including termination, and may be referred to authorities.

Legal Framework and Compliance

• This policy aligns with applicable Workers' Compensation statutes in <Country> and its jurisdictions (e.g., <State/Province>), and with any applicable social insurance programs in <Country>.
• Where compulsory coverage, notices, or posters are required, <Company Name> will display, distribute, or otherwise make accessible required notices in the workplace and via intranet.
• Waiting periods, maximum weekly benefits, compensability rules, and filing deadlines vary by jurisdiction; local addenda should specify exact requirements.
• Nothing in this policy creates a contract of employment or alters at-will employment where applicable.
• Privacy and medical information will be handled consistent with applicable privacy laws and company policy, with disclosures limited to those with a legitimate business need.

Eligibility and Coverage Overview

Employee Eligibility

• Eligible employees are those defined by law in the jurisdiction of employment (e.g., statutory employees). Coverage generally begins on the first day of employment in a covered role.
• Some jurisdictions exclude certain roles or categories; confirm eligibility with <Vendor Name> or Legal.

Compensable Injuries and Illnesses

• Injuries or illnesses arising out of and in the course of employment, including occupational diseases recognized by law.
• Examples include injuries occurring while performing job duties, repetitive strain injuries, and exacerbations of pre-existing conditions when causally related to work.

Exclusions and Limitations (subject to law)

• Injuries resulting from intentional self-harm, illegal activity, or intoxication at work may be excluded.
• Commuting injuries may be excluded except in jurisdictions with specific “coming and going” rules or where employer-provided transport is involved.
• Off-duty activities and personal errands are generally not covered.

Benefits Provided

Medical Benefits

• Reasonable and necessary medical treatment related to the work injury, subject to jurisdictional rules on provider selection (employee choice versus panel networks) and utilization review.
• Covered services may include physician visits, hospital care, diagnostic tests, prescriptions, medical devices, and rehabilitation therapies.

Wage Replacement Benefits (examples; subject to law)

• Temporary Total Disability: Typically <Percentage>% to <Percentage>% of the employee’s average weekly wage (AWW), up to a statutory maximum of <Amount> per week, after a waiting period of <Number> days.
• Temporary Partial Disability: A percentage of wage loss when working with reduced hours or duties.
• Permanent Partial Disability: Benefits based on impairment rating and schedule, or loss of earning capacity, as defined by law.
• Permanent Total Disability: Benefits and duration vary by jurisdiction; consult local addendum.

Waiting Period and Retroactive Pay

• Benefits may commence after a waiting period of <Number> calendar days. If disability extends beyond <Number> days, retroactive benefits may apply as specified by law.

Vocational Rehabilitation and Retraining

• Where permitted, services may include job coaching, skills assessment, ergonomic accommodations, and retraining, coordinated with <Vendor Name> and HR.

Survivor and Death Benefits

• In the event of a compensable fatality, statutory survivor benefits, burial allowances, and dependent benefits will be provided per jurisdictional rules.

Coordination with Other Benefits

• If <Company Name> provides wage continuation or salary supplements, those payments may offset or be offset by statutory benefits, consistent with law.
• Short-Term Disability and Workers' Compensation cannot pay for the same period for the same condition; coordination rules will be in jurisdictional addenda.
• Health plan coverage continues as per standard benefits eligibility rules; premium contributions during leave will follow <Company Name> leave billing processes.

Reporting and Claim Filing

Employee Responsibilities

• Seek first aid or emergency care immediately.
• Notify your supervisor as soon as practicable, preferably within <Number> hours of the incident or knowledge of illness.
• Complete the initial incident report form <Form Name> by <Date/Timeframe>.
• Cooperate with claims administrators, attend scheduled appointments, and provide necessary documentation.

Manager Responsibilities

• Ensure the employee receives prompt medical attention.
• Secure the scene if appropriate and report hazards to Safety.
• Submit the manager incident report <Form Name> to Total Rewards and <Vendor Name> within <Number> hours.
• Provide accurate details, witness statements, and any available video or logs.
• Support transitional duty if medically appropriate.

Total Rewards and Risk Management Responsibilities

• Notify the carrier or third-party administrator (<Vendor Name>) within statutory timelines.
• Coordinate with Payroll for benefit payments and offsets.
• Maintain documentation, track deadlines, and monitor claim outcomes.
• Partner with Safety to address root causes and corrective actions.

Step-by-Step Claim Process

1. Employee obtains necessary medical care and informs supervisor.
2. Supervisor and employee complete incident reporting forms.
3. Total Rewards submits the claim to <Vendor Name> by <Number> business days from notice.
4. <Vendor Name> assigns a claim number, notifies the employee of rights and responsibilities, and begins investigation.
5. Medical provider submits work status reports to <Vendor Name> and Total Rewards.
6. If time away from work is required, Payroll coordinates wage replacement per jurisdictional rules.
7. Total Rewards, <Vendor Name>, the manager, and the employee review return-to-work options.
8. Claim is resolved through recovery, settlement, or closure; records are retained per policy.

Timelines and Deadlines

• Employee reporting: within <Number> hours of injury or knowledge of illness.
• Employer reporting to <Vendor Name>: within <Number> business days of employer notice, or as legally required (e.g., within <Number> days).
• Posting and notice: required notices must be displayed at worksites and digitally on the intranet.

Return-to-Work and Transitional Duty

Principles

• Early, safe return-to-work supports recovery, reduces costs, and maintains connection to the workplace.
• Transitional assignments are temporary, aligned to medical restrictions, and reviewed regularly.

Program Elements

• Obtain medical restrictions on the <Work Status Form Name> from the treating provider.
• Identify suitable transitional tasks within the home department or alternative departments.
• Transitional assignments typically last up to <Number> weeks, with extensions reviewed case-by-case.
• Compensation for transitional duty follows standard pay practices for effective hours worked, coordinated with wage-replacement benefits to avoid overpayment.
• Reevaluate restrictions at each follow-up appointment; update assignment accordingly.

Examples of Transitional Tasks

• Administrative tasks, training, documentation, quality checks, inventory audits, safety observations, and workstation improvement projects.

Ergonomics and Accommodation

• Engage HR and <Ergonomics Vendor Name> for assessments and equipment when appropriate.
• Coordinate with Legal for reasonable accommodation obligations under applicable law.

Pay, Tax, and Payroll Coordination

• Wage-replacement benefits paid by <Vendor Name> or via employer-funded wage continuation are subject to tax treatment defined by law; consult Payroll and Tax for specifics in <Country>.
• If <Company Name> supplements statutory benefits up to <Percentage>% of base pay, Payroll will apply offsets to avoid exceeding pre-injury earnings.
• Benefit calculations use pre-injury average weekly wage determined per jurisdictional rules (e.g., look-back period of <Number> weeks; include/exclude overtime per law).
• Deductions for employee benefits during leave follow standard leave-billing processes; arrears collection and catch-up contributions will be coordinated upon return.
• Overpayments must be corrected promptly; Payroll will recover amounts per company policy and law.

Safety, Prevention, and Investigation

• Safety leadership is central to Total Rewards outcomes; preventing injuries reduces human and financial costs.
• Managers must conduct job hazard analyses and corrective actions after incidents.
• Safety, in partnership with Risk Management, will investigate incidents proportionally to severity, documenting findings, root causes, and corrective actions.
• Use leading indicators (e.g., near-miss reporting, safety observations) and lagging indicators (e.g., OSHA recordables where applicable) to monitor performance.
• Employees have the right and responsibility to report unsafe conditions without retaliation.

Roles and Responsibilities

Employees

• Follow safety policies and training.
• Report injuries promptly and provide complete, truthful information.
• Attend medical appointments and share work status reports.

Managers and Supervisors

• Ensure a safe working environment and enforce safety protocols.
• Facilitate immediate reporting and medical attention.
• Provide light-duty opportunities where feasible; maintain communication with the employee.

Total Rewards

• Own policy governance, vendor relationships, and metrics.
• Submit claims timely, coordinate benefits, and oversee return-to-work.
• Maintain jurisdictional addenda and ensure enterprise consistency.

Risk Management and Safety

• Lead safety programs, incident investigations, and corrective actions.
• Analyze trends, partner with operations, and drive prevention strategies.

Payroll and Finance

• Coordinate payments, tax reporting, and offsets.
• Reconcile carrier invoices, reserves, and claim costs with Finance.

Legal and Compliance

• Advise on statutory requirements, compensability disputes, and documentation retention.
• Manage litigation with external counsel as needed.

Vendor/Third-Party Administrator (<Vendor Name>)

• Adjudicate claims, manage medical networks, and communicate with employees and providers.
• Provide reporting, reserves, and service-level performance data.

Implementation Guidelines for Total Rewards

Program Design and Funding

• Determine insurance structure by jurisdiction: fully insured, high-deductible, or self-insured where permissible.
• Define wage supplementation policy (e.g., supplement to <Percentage>% of base pay for up to <Number> weeks).
• Establish governance for complex claims, including weekly triage rounds with <Vendor Name>.

Jurisdictional Addenda and Compliance Map

• Create and maintain addenda for each <State/Province> with:
  • Waiting periods and retroactivity rules
  • Maximum/minimum weekly benefits
  • Provider selection rules and networks
  • Filing deadlines and required forms
  • Posting and notice requirements
  • Anti-retaliation protections
• Review addenda at least annually and upon legislative change.

Process Controls and Documentation

• Standardize incident reporting forms, manager checklists, and employee communications.
• Implement a case management workflow with timestamps for notice, filing, compensability, and return-to-work milestones.
• Configure document retention periods (e.g., <Number> years post-closure) aligned to legal requirements.

Vendor Management

• Define service-level agreements with <Vendor Name>:
  • First contact to employee within <Number> hours of claim receipt
  • Decision on compensability within <Number> days, unless investigation required
  • Average claim cycle time targets (medical-only vs lost-time)
  • Litigation rate thresholds and escalation triggers
• Conduct quarterly stewardship reviews; monitor incurred and paid loss trends, claim severity, and reserve adequacy.

Data Privacy and Security

• Limit claim access to authorized personnel with a legitimate need to know.
• Store medical records separately from personnel files.
• Use secure file transfer and encryption for data exchanged with <Vendor Name>.
• Publish a data dictionary defining fields shared with vendors and retention schedules.

Training and Awareness

• Provide annual training for managers on reporting, documentation, and return-to-work.
• Provide onboarding education for employees on how to report injuries.
• Include simulations or tabletop exercises for major incident response.

Metrics and Reporting

• Track leading and lagging indicators:
  • Lost Time Incident Rate (LTIR)
  • Total Recordable Incident Rate (TRIR) where applicable
  • Average days to report employee to employer and employer to carrier
  • Average and median claim duration
  • Medical-only vs lost-time claim mix
  • Indemnity-to-medical cost ratio
  • Return-to-work within <Number> days rate
• Publish a quarterly dashboard to Executive Leadership and site leaders.

Coordination with Leaves and Other Policies

• Workers' Compensation leave may run concurrently with other job-protected leaves where legally permissible (e.g., family and medical leave in <Country>), with proper notices.
• Reasonable accommodation processes under disability laws are distinct from Workers' Compensation processes; coordinate but do not conflate.
• Travel, fleet safety, and incident response policies may intersect; align procedures and escalation contacts.

Fraud, Misuse, and Ethics

• <Company Name> prohibits fraud, misrepresentation, and retaliation in Workers' Compensation matters.
• Report concerns via <Hotline> or <Ethics Reporting Portal>.
• Investigations will respect employee rights and follow due process; legitimate claims must not be discouraged.

Dispute Resolution

• Disputes regarding compensability, benefit amounts, or medical treatment will be handled per jurisdictional processes (e.g., mediation, hearings).
• Employees retain all rights afforded by law; <Company Name> will participate in good faith and seek timely resolution.

Records Management

• Maintain claim files for at least <Number> years after closure or longer where required.
• Retain OSHA or equivalent logs where applicable per regulatory timelines.
• Securely dispose of records after retention period ends, following company policy.

Risk Financing and Budgeting

• Annual budgeting will include expected losses, administrative fees, excess insurance premiums, and reserves.
• Apply actuarial analyses from <Actuarial Vendor Name> for self-insured or high-deductible programs.
• Allocate costs to business units using a transparent methodology (e.g., incurred loss plus headcount factor), approved by Finance.

Review and Approval Process

Version Control

• Policy Owner: Total Rewards
• Review Cycle: At least annually, or upon material legal changes
• Change Log:
  • v<Number> on <Date>: Initial release
  • v<Number> on <Date>: Updated wage supplement policy and vendor SLAs

Approvals

• Approved by <Executive Sponsor Title> on <Date>
• Legal review completed by <Legal Contact> on <Date>

Exception Management

• Exceptions must be requested in writing to Total Rewards and Legal.
• Approved exceptions must specify scope, duration, and controls; store in the policy repository.

Jurisdictional Examples and Placeholders

Example Placeholder Values

• Waiting period: <3> calendar days
• Retroactivity threshold: <14> days
• Wage replacement: <66.67>% of AWW, capped at <Amount> per week
• Transitional duty: up to <12> weeks
• Employer claim submission target: within <1> business day of notice
• Record retention: <7> years post-closure

Sample State/Province Addendum Outline

• Coverage trigger and definitions
• Panel physician list or provider choice rules
• Required claim forms and timelines
• Benefit maximums and minimums for the plan year beginning <Date>
• Dispute resolution processes
• Special provisions (e.g., firefighter cancer presumptions, mental injury standards)

Audit and Continuous Improvement

• Conduct annual internal audits of claim files for timeliness, documentation completeness, and payment accuracy.
• Benchmark against industry peers using <Benchmark Source>.
• Review high-severity claims quarterly for lessons learned and prevention strategies.
• Implement corrective actions with owners, due dates, and verification.

Glossary of Terms and Definitions

• Average Weekly Wage (AWW): The pre-injury average earnings used to calculate wage-replacement benefits, defined by jurisdictional rules.
• Compensability: Determination that an injury or illness is covered under applicable Workers' Compensation law.
• Medical-Only Claim: A claim with medical payments but no indemnity wage-loss payments.
• Indemnity Claim: A claim involving wage-loss payments due to disability.
• Transitional Duty: Temporary work assignment within medical restrictions to facilitate return-to-work.
• Maximum Medical Improvement (MMI): Point at which a condition is stable and unlikely to improve significantly with further treatment.
• Third-Party Administrator (TPA): External vendor (<Vendor Name>) administering claims on behalf of <Company Name>.
• Utilization Review (UR): Process to evaluate the appropriateness of medical treatment.
• Reserve: Estimated future cost of a claim used for financial reporting and premium calculations.
• OSHA Recordable: An injury or illness meeting criteria for recording on regulatory logs in <Country>.

Employee Communication and Guidance

What This Means for You

If you are injured or become ill because of your work at <Company Name>, Workers' Compensation is a program that helps pay for your medical care and may replace part of your wages if you cannot work. This benefit is required by law and is provided at no cost to you. If you are ever unsure about what to do, contact your manager or the Total Rewards team at <Contact Email/Phone>.

If You Are Hurt at Work: Simple Steps

1. Get medical help right away. In an emergency, call local emergency services or go to the nearest emergency room. For non-emergencies, ask your manager or HR where to go for care. Some locations require you to choose from a list of approved providers.
2. Tell your manager as soon as you can, ideally the same day. Quick reporting helps us get your claim started and ensures you receive benefits on time.
3. Fill out the incident report form. Your manager will give you the form and help you complete it. Please be as detailed and accurate as possible.
4. Watch for a letter or email from our claims partner, <Vendor Name>. They will assign a claim number and explain next steps. Keep this information for your records.
5. Share your work status after each doctor visit. Ask your doctor to give you a note that lists any work restrictions. Provide a copy to your manager and to Total Rewards.

Pay and Time Off During Recovery

If you cannot work because of your injury, you may receive wage-replacement benefits after a short waiting period. In some places, this starts after <Number> days. The amount is usually a percentage of your average weekly pay (for example, <66.67>%). If <Company Name> offers additional wage support, we will explain how that works. You will not be paid more than your usual pay for the same hours.

Returning to Work

We want to help you return to work safely as soon as you are ready. Sometimes that means doing a temporary assignment with lighter duties or different tasks. We will match your assignment to your medical restrictions. These assignments are temporary and reviewed regularly with you and your manager.

Your Rights and Responsibilities

You have the right to report injuries, get medical care, and receive the benefits you are entitled to under the law. You must report your injury promptly and give us accurate information. We will not tolerate retaliation for reporting an injury or asking for benefits. If you think something is wrong, call <Hotline> or talk to HR.

Who to Contact

• Emergencies: Local emergency services and notify your manager
• Questions about your claim: <Vendor Name> at <Phone/Portal> with your claim number
• Help at work: Your manager and the Total Rewards team at <Email/Phone>

Important Notes

Workers' Compensation rules can vary depending on where you work. We will guide you through the requirements for your location and make sure you get the help you need. This summary is not legal advice and does not change the law in your area. If there is a difference between this summary and the law, the law applies.

A Final Word

Your safety and well-being are our top priorities. Report hazards, ask questions, and let us know how we can support you. Together, we can create a safer workplace and help you recover if an injury happens.

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Document Information:

• Document Type: Workers' Compensation Policy
• Category: Benefits & Wellness
• Generated: August 25, 2025
• Status: Sample Template
• Next Review: <Insert Review Date>

Usage Instructions:

1. Replace all text in angle brackets < > with your company-specific information
2. Review all sections for applicability to your organization
3. Customize content to reflect your company's policies and local regulations
4. Have legal and HR leadership review before implementation
5. Update document header with your company's version control information
6. At bottom of the document you find a short example on how the content could be communicated to end-users, for instance employees.

This sample document is provided for reference only and should be customized to meet your organization's specific needs and local legal requirements.