When your employee suffers a work-related injury or illness, there are several steps you must take to get the workers' comp claim filed and benefits approved.
Following an on-the-job injury or work-related illness, there’s a limited amount of time to report the incident and file a claim. Failure to do so could result in a denial of workers’ compensation insurance benefits.
That’s why it’s important that employers train their employees to immediately report an injury at work. As the employer, you’re typically responsible for submitting a claim to your workers’ compensation insurer, but you’ll first need to gather details and documentation about the incident.
Once you’ve learned of an employee’s injury, your first step should be to instruct your employee to seek medical treatment if they haven’t already. To get the claims process rolling, you’ll need to:
Workers’ compensation laws vary by state, so be sure to check your state’s rules and deadlines to assure you’re in compliance.
While the workers’ compensation claims process can seem complicated, it can be broken down into five basic steps.
As an employer, make sure your employees know that if they become ill or injured on the job, they need to inform you as soon as they are able.
Typically an injured employee is required to provide written notice, and most states set deadlines for reporting injuries. For example, the employer must be notified within 30 days in New York, while other states allow employees a year or more to report an injury.
A variety of injuries may qualify, such as slipping on a wet floor in the office and breaking an arm, or developing carpal tunnel syndrome from repetitive typing.
Some injuries may require immediate treatment at an emergency room or urgent care facility. Others may require a doctor’s visit for diagnosis and medical care. Depending on the state and the insurer, the employee may need to seek non-emergency treatment from a medical provider that’s part of the insurer’s network in order to receive benefits.
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 possible.
Once you’ve been notified of an employee injury, you’ll need to provide your injured worker with information on their rights and workers’ comp benefits, as well as their return to work.
In most states, you’ll give your employee a workers’ comp claim form to fill out and return to you. This form will detail the nature of their injury, along with where, when, and how it occurred. You may also need to have your injured employee fill out a first report of injury form that you’ll submit to your state’s workers’ compensation board.
Which forms are required and who is responsible for completing them depends on the state where you and your employee are based, the type of illness or injury, and the insurer.
It’s a good business practice to include workers' comp insurance information in your new hire employment packet to ensure your employees know their rights if they’re injured on the job. If you fail to provide this information, you could face a lawsuit.
Usually, the employer is responsible for sending the claim form and all supporting documentation to the workers’ comp insurance carrier, but the employee’s doctor will also need to submit a medical report.
Additionally, you may be required to report the injury to your state's division of workers' compensation or workers' comp board. This may apply for all workplace injuries, even if your employee is not seeking workers’ comp benefits.
How long does an employer have to file a workers' comp claim? Typically, the employer has seven days to submit the claim to all necessary parties, including the insurer. This window can vary by state, so it’s important to check your state’s laws.
Once the claim is filed, the insurer will either approve or deny the claim.
If a claim is approved:
Once a claim is approved, the insurer will inform the employer and contact the employee with payment details. At this point, the employee and their workers’ compensation lawyer (if any) may:
If a claim is denied:
If your workers’ comp insurer denies benefits, the employee has the option to:
How do I know if my workers’ comp claim is approved?
Within a few weeks you should receive a written notice of the outcome of your claim: approved or denied. If you haven’t heard from the insurance carrier handling your workers’ compensation case, contact the insurance adjuster or claims administrator directly.
Once an employee has recovered from an injury and is able to return to work, they’re required to provide written notice to both their employer and the insurance provider. Depending on the severity of the injury, the insurance company may have to pay permanent disability benefits.
Many employers choose to implement a formal return to work program, aimed at getting workers back to work and productive as quickly as possible. These programs may involve offering an injured worker modified duties, or training employees on other skills if they’re unable to resume their regular responsibilities.
An employee’s injury or illness likely qualifies for workers’ compensation benefits if it occurred on the job or within the scope of employment. This includes occupational illnesses or occupational diseases caused by exposure to harmful chemicals or other hazards while on the job.
In order to file a claim, all of the following must be true:
It’s important to learn your state’s workers’ compensation laws and follow their requirements regarding the workers’ compensation process. Failure to do so may result in costly fines and penalties.
In addition to keeping an active workers’ compensation insurance policy, make sure you:
If you need workers’ comp coverage for your employees, compare quotes online with Insureon today to avoid penalties and business risks. Most small businesses can get workers’ comp coverage in 24 hours, depending on the state.