How to File a Workers Comp Claim

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Workers' compensation insurance is required for businesses in most states, although the rules about when it's needed can vary. It protects both businesses and their employees when someone is injured at work. Employers are typically responsible for filing a claim with their insurance provider when an employer is injured or off work due to illness. According to the Bureau of Labor Statistics (BLS), 3.4 workers' compensation claims are made for every 100 full-time workers every year. However, of the millions of employees who are injured at work each year, less than 40% file a claim.

Premiums for workers comp can be expensive. And it’s a waste if you don’t use the policy when needed. There is a limited amount of time for filing a claim, so it's important to get the process started as soon as possible.

Of course, to do this, you first need to understand the process in how to file a workman’s comp claim and your role in it. Ensuring your business is protected with the best workers' compensation insurance available is essential too. Comparing quotes will help you to find the best deal.

When Should You File a Workers Compensation Claim? 

Filing a workers' compensation claim correctly starts with knowing when you should be filing a claim. When an employee is injured or ill while doing their job, it's important to file a claim to gain the appropriate workers' compensation benefits. 

Employers should notify their insurance provider as soon as they become aware of a workplace injury of an employee. This includes most accidents and injuries occurring due to work activities, equipment, or the work environment. 

Workers have the responsibility of reporting incidents as soon as they occur, or they could risk a delay in filing and subsequently having the claim turned down. The employee should make sure they fulfill their responsibilities, such as giving the employee the necessary paperwork to file the claim.

What Does Workers Compensation Cover? 

Before understanding how to file a workers comp' claim, you need to know when your insurance is going to cover the claim. There's no point in spending time filing a claim if it won't be covered. 

Some of the circumstances when the claim won't be honored include: 

• Stress or mental health injuries/illnesses 

• Self-inflicted injuries 

• Injuries resulting from fighting or employees playing around 

• ing company policy, or while under the influence of alcohol or drugs 

When an injury occurs over time, it can be a little more difficult to determine whether it's a claim that will be covered. When this occurs, the time for filing typically begins when the employee takes time off work because of the injury or they know that the injury is caused by work. There is a time limit on how long you have to file workmans comp claim, so it's important for both the employer and employee to be proactive. 

When a claim is approved, the benefits provided may cover the costs of medical bills, lost wages, or disability payments. 

What Does the Workers Compensation Claim Process Involve? 

There are several steps that will need to be taken when filing workers comp claim paperwork. 

Before doing anything else, the first thing an employer should do is ensure their employee seeks medical treatment. Not only is this your responsibility as a caring employer, but it also ensures there is key evidence that can be used in the claim. 

Additionally, in the workmans comp claim process, you will need to ensure you give your employee any necessary paperwork, interview witnesses when necessary, and submit completed forms and evidence. If it's required in your state, you will also need to report the injury to the workers' compensation board. 

How to File Workers Comp Claims?

These are the key stages of how to file workman's comp claims. Pay attention to each one to ensure you and your employee follow the process correctly.

Receive an Injury Report

Firstly, in how to file a worker's compensation claim, an employee needs to report an injury to their employer. It's important to train employees on when they need to do this and ensure they make reports as quickly as possible. Be sure to stress that it's in their own interest to report any injuries as soon as they can so that a claim can be filed as quickly as possible. Employees should inform you as soon as they are able to, and are usually required to do so in writing. Most states have deadlines for when injuries need to be reported.

When an injury requires medical treatment, this is a matter of priority, especially in an emergency. However, non-emergency medical care might be required in order for workers' compensation benefits to be awarded.

Work With the Employee to Complete the Paperwork

Completing the necessary paperwork is the next step after an employee has reported an injury. The employee may need guidance on how to file a worker's compensation claim and support in filling out any necessary forms. You will need to give your employee relevant information on their rights and responsibilities, and what workers' compensation benefits they may be entitled to.

To file a workman's comp claim, you will usually provide your employee with a form to fill out with the details of the injury. After completing it, they will give it back to you so that you can include it in the claim. They will use the form to provide details of the injury, including how, when, and where it occurred. Additionally, you might need to complete a form for your state's workers' compensation board.

Different insurers may have different forms they require you and the employee to complete too. The type of injury could also affect what information you need to provide and how the claims process works.

Make a Report

After the employee has returned the form, the next step is for the employer to report the injury and file the claim form with their insurer. You will need to send any forms and supporting evidence to your insurance provider so that all relevant information is provided. The employee's doctor will also need to provide a report on the injury and how it has affected the employee. If you are required to make a report to your state's workers' compensation board, don't forget to do this at the same time. This is sometimes required regardless of whether a claim for workers' compensation benefits is being made.

Wait to Hear From the Insurer

Once you file workman's comp claim forms and any supporting evidence, you will need to wait for the insurer to make a decision. The insurance company will carry out an investigation to determine the legitimacy of the claim and what will happen next. They will respond either approving or denying the claim, at which point you can take the appropriate next steps. The deadline for a decision is usually somewhere between two to four weeks.

If the claim is approved, the insurance provider will give you details of payment. The employee may choose to accept the offer or negotiate. They might be working with a lawyer to help them get the best results, who can give them advice on what to do.

The employer could also appeal an approved claim, but they need to have probable cause to do so. This might include reasons such as unlawful conduct by the employee.

If the claim is denied, they could ask for a consideration from the insurance provider or make an appeal. The appeal process is typically conducted through the state's workers' compensation board.

Inform the Insurer of the Employee’s Return to Work

The final part of the workman's comp claim process is the employee informing the insurer and their employer when they return to work. They will need to provide written notice so that both employer and insurer have clear evidence of their intended return to work.

As their employer, you might help them to return to work by supporting them in adjusting their duties or making a staggered return to work. After they have returned to work, the insurance company could continue to make payments if the injury resulted in an ongoing disability.