Businesses must follow the state’s rules for reporting an employee’s injury and filing a workers’ comp claim. There are rules guiding the claim process, which must be followed diligently to receive the desired benefit after filing a claim. Only businesses with workers’ compensation insurance can file for those benefits if an employee suffers an on-the-job injury or occupational illness like carpal tunnel syndrome. Workers’ compensation claims cover medical care costs and lost wages during the recovery period until the employee returns.
This article reviews the workers’ compensation claim process and the steps an employer must follow to file a claim from its insurance company and state workers’ compensation board.
What is Workers Compensation, and Why is it Important?
It is an essential policy every business needs to carry to cover the costs of medical treatment for an injured employee and other associated costs. It protects businesses from financial expenses resulting from workplace injuries. They could be due to an accident on the job site or an illness while delivering expected services. For injured workers, this policy ensures they receive benefits and medical care. Most states require businesses to carry this insurance before they are eligible to offer employment, especially those that carry out construction services.
Employees should file a workers’ compensation claim after an injury as soon as possible. Some states give a maximum duration of 30 days to file it, while it may be lesser in other states. It usually requires them to fill out a form, attach their medical report, and other necessary paperwork.
Employees that need immediate medical attention or urgent care should use an emergency medical treatment facility to get the necessary treatment and services as soon as possible.
Steps to File Workers Compensation Claim
There are specific steps employers looking to file workers’ comp for an injured person must follow. The process is straightforward but needs guidance to ensure an employee’s claim isn’t rejected. The highlighted steps below should guide employers through the workers’ compensation claims process:
Determine If Your Employee is Eligible for Worker’s Compensation
An employer must ascertain the eligibility status of any employee that claims workers’ compensation benefits before filing a claim form and following other due processes. Any employee making such a claim must prove they are injured, and the injuries are work-related or happened on the job site. The injury report must include the date, cause, and other necessary information.
It’s also vital for employers to confirm that an injured employee is covered under their business insurance policy. Workers under a subcontractor aren’t a part of the general contractor’s liability. Thus, they’re not eligible even if they sustain injuries while on the project.
Gather Necessary Information to File the Claim
The information required for this claim varies from insurer to insurer. You can visit the website of any top insurance company or contact a trusted insurance agent to have an idea of the information you’ll need to provide. Ensure the information provided is accurate and back up claims with necessary proofs. For example, if you’re making illness claims, you need a medical report to back such claims up. Mostly, the general information you’ll need is the date, time, place, and causes of the injury.
Complete the Workers Comp Claim Form
Input appropriate details requested in the form, and ensure you do not make mistakes while filling it. It is the details in this form that your insurance company and other authorized body will consider before giving their final verdict. Ensure you fill it correctly to avoid delay in reviewing your injury claims due to wrong information.
Submit the Completed Form & Supporting Documents
After you fill the form with accurate information, the next thing is to submit the form through mail or other designated mediums. Ensure that you attach other necessary supporting documents like the medical reports, medical bills, etc., to the form before sending. It’s also vital to demand an acknowledgment upon receipt to ensure that the appropriate bodies have received the form. Leaving alternative contact means is another necessary precaution most people overlook.
Wait for Approval
The state’s workers’ compensation board reviews the application form and other necessary documents. Their findings about the claim, after reviewing, influence their decisions greatly. If the claim application is approved, the employee receives benefits and medical care for the injury. In a case the claim was denied, you can file for an appeal if the claim was denied. Be sure to seek professional guidance from your attorney when filing an appeal.
What makes an employee eligible to receive workers’ compensation benefits?
To receive workers’ comp benefits, you must tick three vital boxes. Firstly, the employer must carry an up-to-date policy. Next, the injured worker must be a direct employee under such an employer. The policy won’t cover any injured worker that’s not directly employed by an insured employer. Lastly, workers comp only covers work-related injuries or occupational diseases. Hence, your injuries or illness must be work-related. Any accident outside the workplace that results in injury isn’t covered under this policy. The business won’t bear medical treatment costs or pay for lost wages.
What Can make an Insurance Company or the State board deny my claims?
Any claim that can’t be backed with verifiable proof will most likely be rejected. Also, it’s vital to provide accurate information in the claim form. Any contradicting information may not be overlooked by those reviewing your application. The state board receives a lot of false claims daily, so it’s only normal that the review process becomes stricter. One thing you can have in mind is that if your claims are true, there’s 95% certainty that the application won’t be denied.
What Can I Do If An Employer Refuses to Process my Claim?
No employer should refuse to process an employee’s claim without genuine reasons under the law. Such an employee can seek the help of an attorney to mediate the issues between both parties. Delay in filing the benefits claim can make the employee miss out on the benefits and medical care. Thus, such matters should be resolved as quickly as possible.
Carrying a worker’s comp policy helps owners protect their businesses and employees. Every company looking to hire employees must contact a reputable insurance agent to find the best workers comp insurance that suits their services and budget. Seeking insurance advice and working with reputable agencies like Farmer Brown can help ease the purchase process. You get the right coverage for your business at the best premium. Visit their site today to enjoy the limited deals on workers’ comp policy.
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