In our previous post, we discussed that the best way for small-business owners to handle a Workers’ Compensation Insurance claim is through open channels of communication. Now that you understand how to navigate a claim in general, it’s time to talk about specifics. In the event of an accident, how does a small-business owner go about filing a Workers’ Compensation Insurance claim?
Before we get started, it’s worth emphasizing that Workers’ Compensation Insurance is regulated at the state level. While the general procedure is roughly the same, the details vary slightly from state to state (as do Workers' Comp costs. More on that here: Workers' Comp Insurance Cost Analysis).
To learn more about your obligations, contact your state’s Workers’ Compensation Insurance Board (or similar entity). You can easily find your board’s contact information by visiting your state’s page in our guide to Workers’ Compensation state laws.
My Employee Is Injured. What Now?
Let’s start by detailing an employee’s responsibilities. When an employee is injured or develops an occupational illness, they must report it to you as soon as possible. Make sure your employees understand that each state has a different reporting period. If they wait too long to notify you, they could forfeit their benefits.
Some states have a reporting window of just a few days, while others allow a couple years. In any case, it’s better that employees report sooner rather than later. Here’s what happens after the injury notification:
- Employee receives proper paperwork. You must give injured employees information that details the claims process, their benefits, their rights, and information about the business’s Workers’ Compensation Insurance provider. You will also supply the employee with all of the appropriate paperwork, including a reporting form. The necessary forms vary depending on your state and the type of injury / illness in question. Note: employees should report all on-the-job injuries – even small scrapes – to their supervisor. Minor injuries can usually be treated with first aid to prevent them from becoming bigger issues.
- Employee visits an approved healthcare professional. Unless it is an emergency that requires an emergency room visit, an employee must visit a healthcare professional for their injury. The doctor will supply a medical report that will be filed along with the claim. In some states, only approved, in-network medical practitioners can provide assessments for Workers’ Compensation claims. In others, employees have the right to choose their healthcare professional. Employees should understand these restrictions (if any) and know that they should seek medical assistance right away. Delays in medical treatment can put their benefits at risk.
- Employer files the claim. The paperwork for filing a claim differs from state to state, so you’ll want to make sure you are using the proper forms. In some cases, your insurance provider may be able to supply you with the forms. Then, you file the claim with your insurance company. In some cases, you may need to submit documentation to your state’s Board of Workers’ Compensation Insurance. Be aware that there are reporting deadlines that vary from state to state. Note: you may be required to notify your state’s board of ANY workplace injury or illness – even if it’s not eligible for Workers’ Compensation benefits.
- Insurance provider notifies the WC Board of their decision. Your insurance provider will either approve or deny the claim and alert your state’s board of the decision. If the claim is denied, your employee can appeal. If the insurer approves the claim and you believe it shouldn’t be, you can usually ask that the decision be reviewed.
- Employee receives benefits. If the Workers’ Compensation claim is approved, your employee will start receiving benefits. Most policies help pay for medical expenses, medications, rehabilitation costs, and two-thirds of their wages if an employee is unable to work for a certain length of time.
- Employee returns to work. In many cases, an employee must submit more paperwork alerting the employer (and the insurance company) that they are able to return to work.
For more information on the mechanics of Workers’ Compensation Insurance, check out our post “How Does Workers’ Comp Insurance Work?” on our blog.
Why Employers Must Follow Proper Workers’ Comp Reporting Procedures
As we’ve mentioned, each state has a slightly different way of handling Workers’ Compensation Insurance claims. But following the correct procedure – and supplying employees with the proper information so that they may do the same – is of utmost importance. Why? Because employers can be fined for Workers’ Comp transgressions, such as…
- Not carrying Workers’ Compensation Insurance.
- Not supplying employees with accurate information.
- Failing to report injuries or file claims on time.
- Misclassifying employees and / or injuries.
- Influencing a medical practitioner’s diagnosis.
- Appealing a claim without probable cause.
Need a real-world example? Check out how much Jim Carrey was fined for violating New York’s Workers’ Compensation laws.
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!