The process of filing a workers’ compensation claim begins when an injured worker reports an incident within the allotted time frame, completes any necessary forms, and also seeks relevant medical care.
With different rules in each state, workers’ compensation insurance can become complicated. If this is the case, an employee may want to hire the expertise of a lawyer like those at https://trulaw.com/.
However, before it gets to that stage, here are the steps that an employer must follow to file for a workers’ compensation claim.
What Qualifies As A Workers’ Comp Claim?
Most injuries that are sustained while on the job are completely covered by workers’ comp insurance if they are reported within a set amount of days. This includes illnesses and accidents that are caused by exposure to work materials, equipment, and activities, such as:
- An illness that comes from exposure to hazardous workplace materials
- Any broken bones from a fall on slippery floors
- Carpal tunnel syndrome or other repetitive stress injuries
In some cases, the employee may require urgent treatment. To receive workers’ compensation benefits in non-emergency, your insurance company might request that the employee seek medical care from an in-network provider.
The worker’s comp claim does not cover:
- Self-inflicted injuries
- Stress or other psychiatric disorders
- Injuries caused by horseplay or fighting
- Injuries incurred while under the influence of alcohol or drugs, or while violating company policies
When Should An Employer File A Workers’ Compensation Claim?
An employer should report illness or injury if the person:
- Is an employee
- Received an injury while performing job duties
- Becomes ill from their line of work
If an employer does not file a workers’ compensation claim within the allotted timeframe, the employee may not receive any benefits!
What Information Is Needed?
When an employer filed a workers’ compensation claim with their insurance company, they will need to include the parent company name, the account number, a location code, and a policy number.
In addition, they will need to send the employees information:
- Name, age, address, gender, phone number, and date of birth
- A Social Security number
- Marital status
- Number of dependents
- Hire date and years in current position
- Accurate wage information
Information for the Claim Form
There is some important information about the incident that must be included on the claim form to provide much-needed context for the incident.
- Date and time of the incident
- Cause of accident
- Time of initial report
- The exact type of injury or illness and where
- Where it occurred on the business property
- Witness information
- Employee’s medical care information relating to the accident
- Days of missed work
- Estimated return to work date
1. Employee Reports An Injury To The Employer
A work-related injury occurs and an employee reports the injury to their employer including the time, date, type of injury, and how it occurred. This must be done within 30 to 45 days of the injury and can be completed in person, or via a letter or email.
If it’s an emergency, the employee must seek near-immediate medical attention. If it’s not an emergency, the employee must visit a relevant medical provider.
2. Employer Files A Claim
After receiving proof of the work injury, an HR representative or supervisor should provide the necessary paperwork to the employee. Once this has been filled out, they can then file a report of the injury to the workers’ comp insurance provider.
3. Insurer Approves Or Denies The Claim
The workers’ compensation insurance company will analyze all evidence to determine whether a claim is approved or denied.
If it’s approved, the employee can accept the payment offered by the insurance company to cover items like lost wages and medical bills, or they might be able to negotiate for a larger lump-sum settlement. However, if the claim is denied, the employee has the right to appeal the decision.
An employee might also periodically choose to follow up on the status of their claim.
4. Employee Returns To Work Or Appeals The Denied Claim
Once the employee has returned to health, they will return to work (either full or part-time) unless the injury has left them without this ability. If the workers’ compensation claim is denied, the employee can seek professional legal help for the next steps.
This is everything you need to know about filing for a workers comp claim. Sure, it can be a little complicated but provided an employee reports the incident as soon as possible, everything should be in order.