For an injured employee to receive benefits, the worker needs to follow the correct workers’ compensation claims process, including filing a claim before the state deadline.
If a worker is injured on the job, there is a limited amount of time to submit paperwork in order to receive workers’ compensation benefits. Both the worker and the employer must act promptly when an injury occurs. Otherwise, the claim could be denied.
When an injury occurs, the employer must:
The employee must:
The workers' compensation process can vary depending on where the employee is located since workers’ comp is regulated by the state.
An employee should file a workers’ compensation claim if injuries were sustained on the job or within the scope of employment. This includes occupational accidents, diseases, trauma injuries, or illness caused by exposure to work activities or chemicals.
In order to file a claim, all of the following must be true:
To make a workers' comp claim, the employee's injury or illness must be work-related. A variety of injuries may qualify, such as slipping on an icy patch in the business parking lot or developing cancer from exposure to toxic substances in the workplace.
In emergency situations, the employee should be rushed to a hospital emergency room. For less immediate concerns, injured workers should go to a doctor to get a diagnosis and receive a medical report to file with the workers’ comp claim.
Depending on the state and the insurer, the employee may need to visit a medical provider that’s part of the insurer’s network to receive benefits.
The employee should provide written notice of the injury as soon as possible. Reporting deadlines vary by state. For example, the employer must be notified within 30 days in New York, while other states allow employees up to a year or two to report the injury.
With injuries or illnesses that surface over time, such as mesothelioma (caused by exposure to asbestos), the employee should report the illness as soon as symptoms occur.
Once the employer has been notified about the injury, the employer should give the employee:
The forms the employer will need to provide to the employee depend on the state where the employer and employee are based, the type of illness or injury, and the insurer.
If possible, employers should provide this information before the injured employee seeks treatment. Some businesses include workers' comp insurance information in the employment packet for new hires. Failure to provide this information to injured employees could lead to lawsuits.
Usually, the employer is responsible for submitting the paperwork to the workers’ comp insurance carrier, but the employee’s doctor also needs to mail a medical report.
Additionally, employers may need to submit documentation to the state workers' compensation board. This may apply for all workplace injuries, even if the employee is not seeking workers’ comp benefits.
Once the claim is filed, the insurer will make a determination. If the claim is approved, the insurer will contact the employee with payment details. If the insurer doesn’t think the claim qualifies for workers’ compensation benefits, it will be denied.
The rest of the process is between the employee and their legal representation (if any), doctors, and the insurance company.
If the insurer approves the claim, the employee can:
If the insurer denies the claim:
In both instances, the insurance provider will notify the workers’ comp board of its decision.
The employee must notify both the employer and insurance company via written notice when the employee has recovered sufficiently and wishes to return to work. Depending on the severity of the injury, the insurance company may continue paying disability benefits.
If employees continue to experience occupational injuries, a company’s workers’ comp premium may increase. To avoid injuries and premium increases, employers should provide adequate safety training to ensure workers can perform job duties in a safe manner.
Failure to follow any of these steps with your state’s mandated workers’ comp claims process can result in fines:
If you need workers’ comp coverage for your employees, compare quotes online with Insureon today to avoid penalties and business risks. Most small business can get workers’ comp coverage in 24 hours, depending on the state.