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What Constitutes a Workers’ Compensation Claim?

15. May 2014 08:45

Patient going into MRI machine

When an employee is injured on the job or develops an occupational illness, they have two options: sue the employer or file a Workers’ Compensation claim. Filing a claim means the employee can receive medical coverage, wage replacement, and other benefits. To access these benefits, both the employee and employer must follow certain steps to ensure the injury is compensable.

The claims-filing process can be a bit complex because there are several parties involved: the employee, the employer, the insurance company, doctors, and the state’s Workers’ Compensation Board, to name a few. Read on for more details about how this process works and the statue of limitations for filing a claim.

When to File a Workers’ Comp Claim

Your employee is eligible for Workers’ Comp benefits so long as the following statements are true:

Most injuries that occur on the job or fall within the scope of employment can be covered by Workers’ Comp. This includes occupational accidents, diseases, trauma injuries, or illness caused by exposure to work activities or chemicals. For more information, check out our post “What Do Workers’ Comp Benefits Cover?

On the other hand, Workers’ Comp generally doesn’t cover…

As soon as an employee suffers a covered occupational injury, the clock is ticking. Workers’ Comp claims are time sensitive, which means your employee has a limited number of days to report the incident and collect benefits.

Typically, as soon as the worker suffers an occupational injury, they should report it to you. If they delay filing the report, your Workers’ Compensation Insurance provider could potentially deny your employee their compensation benefits. The delay may also give your carrier the impression that the claim isn’t legitimate.

For cumulative work injuries or illnesses, the area gets a little grayer. For example, say a technical writer develops carpel tunnel syndrome over time. Generally, the clock starts ticking on this claim when…

How to File a Workers’ Comp Claim

To initiate the claims process, an employee must…

From there, the insurance company will choose a doctor to conduct an independent medical examination (IME). The doctor will report the results to the insurance company, which uses the report to create its compensation offer.

It’s worth noting that the Workers’ Comp claims process may differ slightly from state to state. To learn more about your state, be sure to check out its Workers’ Compensation Board.

Workers’ Compensation Statue of Limitations

Different states also have different statues of limitations for filing Workman’s Comp claims. That means depending on where you live, your employees will have a specific deadline for filing a claim (which may vary based on the type of injury). For example, in Maryland, the statute of limitations for filing a Workers’ Comp claim is two years from the date of the injury.

Another deadline is the amount of time an employee has to notify their employer about the injury. In most cases, they must notify you within 30 to 45 days of their injury. For example, in Missouri, employees who fail to notify their employer within 30 days of the injury can jeopardize their ability to receive Workers’ Compensation benefits.

The notification can be formal (e.g., a letter or email detailing the work injury) or informal (e.g., an employee mentioning that their wrist hurts from typing all day). To err on the side of caution, always ask your hurt employee to submit a written notification of their injury, detailing the nature of the ailment and when, how, and where it occurred.

This post is part of an ongoing series on Workers’ Compensation Insurance and the high cost of occupational injuries. Stay tuned for more on how to handle work injury claims, adhere to state Workers’ Comp laws, and find affordable coverage!

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Risk Management | Small Business | Small Business Risk Management | Tips for All Small Businesses | Workers' Compensation Insurance

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