Employers need to follow a few steps when filing workers' compensation claims. The process begins when an injured worker reports an incident, completes the required forms and seeks medical care.
Workers’ compensation insurance, also known as workers’ comp, is an important coverage to have because it can help your employees recover from work-related injuries or illnesses.
If one of your employees tells you they got sick or injured from their work, it’s important to file a workers’ compensation claim with your insurer right away.
The first step of the workers’ compensation claim process begins with your employee notifying you (the employer) of a workplace injury or illness. The time an employee must provide written notice of a workplace injury will vary in each state and can range from a few days to up to a year or more. Regardless of the timeline set by your state laws, you should educate and train your employees to report workplace injuries as soon as possible.
Some workplace injuries, like slipping on a wet floor and breaking an arm, may require immediate medical treatment at an emergency room. While other injuries or illnesses that happen on the job may require a doctor’s visit for diagnosis.
If you’re told someone got hurt or sick from their job, make sure they get appropriate medical care. You’ll also want to give your employee a claim form to complete so they can apply for workers’ compensation benefits. The employee should fill out the form and return it to you. Only the employer can submit the workers’ comp claim form. Without a completed form, your employee can’t get workers’ compensation benefits that could help them recover and return to work.
In some states, you may also need your employee to fill out a First Report of Injury form that you’ll need to submit to your state’s workers’ compensation board. Keep in mind that the forms you need to fill out often will depend on where you and your employees are located, what type of injury or illness occurred and who your insurance provider is.
After your employee provides a completed form, you’ll need to file a workers' compensation claim with your insurance company. This notifies your insurance carrier that a new claim is ready to be processed.
Be sure you understand how to file workers’ comp according to your state laws. Every state has a time limit to file a workers’ compensation claim. For example, New York employers have to file a claim within 10 days of an accident. In most cases, the employer is responsible for submitting the claim form and any supporting documentation, but your employee’s doctor may also need to submit a medical report, too.
Depending on what state you’re in, you may be required to report the injury to your state’s division of workers’ compensation or the state’s workers’ compensation board.
Your insurance provider will either approve or deny your claim once it’s been submitted and reviewed. If the claim is approved, your insurer will inform you (the employer) and contact your employee with payment details. The employee can either accept insurance company’s offer consisting of medical bills, medicine, disability payments and a portion of lost wages, or they can negotiate for a lump-sum settlement or larger structured settlement.
If the claim is denied, your employee can request a reconsideration from the insurance provider or file a formal appeal through their state’s workers’ compensation board.
Depending on the injury or illness, you may need to make changes to help your employee do their job when they return to work. In some cases, you may have to train them to perform a new role.
Even if your insurance carrier decides to deny the claim, your employee can dispute their workers’ compensation benefits or file an appeal. Check your state’s claims process for workers’ compensation cases so you know what to expect.
It’s important to make sure your business is following your state’s workers’ compensation laws. Failing to meet your workers’ comp employer obligations can result in expensive fines and other penalties against your business. Be sure to follow these best practices:
With different rules by state, workers’ compensation insurance for small businesses can get complicated. We’re here to help simplify it with answers to common workers’ compensation insurance questions.
