Submitting A Workers Comp Claim

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When a work-related illness or injury is suffered by an employee, there are a number of steps involved in submitting a workers comp claim and getting the benefits approved. Following a work-related illness or on-the-job injury, there is a limited window of time in which to make a report of the injury and file the claim. Failing to do this could result in the workers’ comp. insurance benefits being denied.

As such, it is essential that employers train their workers to report any injury at work immediately. As the business owner, you are normally responsible for submitting a workers comp claim to your insurance provider.

Steps Involved in Submitting a Workers Comp Claim

Worker Reports Injury to His or Her Employer

As a company, ensure your employees are aware that if they become injured or sick on the job, you need to be informed as soon as they can do so. Typically, an injured worker is required to give written notice and deadlines are set by most states to report the injury.

Employer Directs the Wounded Worker on Required Paperwork

After being notified of any injury to a worker, you will need to supply your injured employee with information on his or her rights, workers’ compensation benefits and information on his or her return to work. In nearly all states, you will be required to provide your staff member with a workers’ compensation claim form to complete and return to you. The form will outline the nature of the injury, in addition to when, where and how it happened.

Injury is Reported by the Employer and the Claim Form Filed

Typically, the company is responsible for submitting the claim form and the supporting documentation to the insurance provider; however, the worker’s doctor will need to present a medical report as well. Furthermore, you might be required to make a report to the workers’ comp board or the division of workers’ comp.

Claim is Approved or Denied by the Insurer

Following the submission of the claim, the insurance provider will either approve or deny it.

In Case of an Approval

Following the approval of a claim, the insurance provider will inform the business owner and the employee will be contacted with payment details. At this time, the worker and his or her workers’ compensation attorney (if applicable) could:

 Accept the payment offer from the insurance company, which might cover medical costs, disability payments, medicine and a percentage of lost wages.
 Negotiate for a larger structured settlement or lump-sum settlement.

In Case of a Denial

If the workers’ comp benefits were denied, the worker can:

 Ask the insurance provider for a reconsideration from
 Formally file an appeal; this is typically done via the state workers’ compensation commission or board.

Worker Resumes Work

When a worker has recovered and is able to resume work, he or she is required to supply both the employer and insurance provider with written notice. If the injury is severe, permanent disability benefits be required from the insurance company.