Workers’ Comp Claims Process: A Checklist for Business Owners
If an employee experiences a work-related injury, there are several steps you as an employer must take to file the claim and get benefits approved. While the workers’ comp claim process can be complex, you can make it easier by educating yourself before there’s an accident and having a workers’ compensation claim checklist on hand.
What Is a Workers’ Compensation Claim?
An employee’s injury likely qualifies for workers’ compensation benefits if it occurred on the job or within the scope of employment. Common claims include burns, slips and falls, and repetitive stress injuries.
Certain injuries may be excluded from coverage, such as:
- Self-inflicted injuries
- Injuries sustained while commuting
- Stress-related injuries
- Injuries occurring while violating company policy
How Does a Workers’ Compensation Claim Work?
When it comes to reporting a workers compensation claim, the employer is responsible for submitting the claims information and other supporting documentation to the workers’ comp insurance carrier. Once a claim is filed, the insurance company will review the details of the employee’s injury and determines the outcome.
When To File a Workers’ Comp Claim?
Workers’ compensation insurance provides employees with a set time frame in which they can file a claim with their employer. This time frame can vary by state. Failure to report the incident and file a claim within this time frame could result in denial of workers’ compensation insurance benefits.
How To File a Workers’ Compensation Claim
The workers’ comp claims process includes specific steps that both you and your employee need to take to ensure that a claim filing goes smoothly. Having a written process for employees to follow can be helpful to avoid confusion or potentially costly mistakes. Here are the most important steps to take after an employee is hurt at work.
Step 1: Report and Assess the Injury
Employees must report injuries to their supervisor right away. This allows time for the injury to be assessed and determine whether medical treatment is necessary. If you have a workers’ compensation policy with Westfield, direct your injured employee to call the 24/7 nurse triage hotline.
Step 2: Complete a Workers’ Comp Claim Form
Once the injury is assessed and treatment rendered, have your employee complete a claim form as they will need this to help you apply for and receive workers’ compensation benefits. This form will include specific information on the injury, including:
- Date and time of the injury
- Nature of the injury
- What happened, in detail
- Names of individuals who witnessed the injury, if applicable
Step 3: Document the injury
Documentation can be central to an employee’s workers’ compensation claim. As the employer, it can be helpful to take photos or video of the injury and the area where the injury occurred as soon as possible. When documenting the scene of the injury, look for anything that may have contributed to the accident, such as wet floors or exposed electrical cords.
Witnesses will need to be interviewed and provide a statement about what they observed when the accident occurred. This can help you to clarify what happened while identifying any potential hazards that need to be addressed to prevent additional injuries.
Step 4: Submit Form and Supporting Documentation
In addition to the official claim form, you’ll want to submit any supporting documentation, such as witness statements. Once all forms are complete and documentation is gathered, send it to your workers’ compensation insurance carrier so they can begin processing the claim. Make sure you are filing your workers’ compensation claim according to your state laws.
You’ll want to have your policy number, location code (if applicable), and company name, handy when reporting a workers’ compensation claim.
Step 5: Wait for Claim Approval or Denial
The resolution process for workers' compensation claims can take several weeks or several months, depending on the severity of the claim. Once a determination has been made, your insurance company will notify you and your employee of claim approval or denial.
If your claim is approved, the employee will need to work with the insurance company to receive reimbursements and any other applicable benefits. If a claim is denied, the employee has the right to request reconsideration or file an appeal. The appeal may go to the state workers’ compensation commission or board, which can extend the claims process.
Workers’ Compensation Claim Checklist
When filing a workers’ comp claim, make sure you can check off the following items. If you can, your claim should proceed with a minimal amount of stress to you and your employee.
__ A thorough investigation of the accident has been completed and documented.
__ The First Report of Injury or claim form has been completed and was sent to your insurance carrier within 24 hours following notice of the injury.
__ All necessary investigative information has been sent to your insurance carrier.
__ The employee’s payroll information has been sent to your insurance carrier.
__ Your insurance carrier has been notified of the employee’s return to work date, if applicable.
__ All legal and state correspondence was sent to your carrier within 24 hours of receipt.
__ All medical bills and reports received have been forwarded to your insurance carrier.
__ Any objects or broken parts of a machine involved in the accident have been preserved for inspection.
__ The injured employee has been given your insurance carrier’s phone number in case they have questions or need an explanation of benefits.
Should I File a Workers’ Comp Claim?
As an employer, you should notify your insurer as soon as you’ve become aware of the work-related injury. Make sure you understand and follow your state’s workers’ compensation laws. Failure to do so may result in fines and other penalties.
Finding a Workers’ Compensation Insurance Carrier
As an employer, it’s important to choose an insurance provider that offers services and programs that help control workers’ comp claims costs, manage loss exposure and get employees back to work quickly and safely. Westfield offers a full suite of workers’ compensation programs, including our 24/7 nurse triage and pharmacy benefit program.
An independent Westfield agent is waiting to help customize the right package of protection for your business. Contact an agent today to get started with a workers’ compensation quote.