How to file a workers' comp claim
You will need to file the proper paperwork, submit it to the right parties, and then follow up when your employee is ready to return to work. However, the specifics can vary by state.
If you’re like a lot of business owners, you’re probably an expert at juggling multiple tasks to keep your business going. One task you hopefully never have to contend with is what to do if an employee gets sick or injured on the job. But if it does happen, workers’ compensation insurance will provide benefits to an employee who suffers an occupational illness or injury.
But what’s your role in the workers’ comp claims process? You will need to file the proper paperwork, submit it to the right parties, and then follow up when your employee is ready to return to work. However, the specifics can vary by state. If you need to file a claim, here’s what you should know first.
As an employer, below are the steps in the workers’ comp claims process that you’ll want to follow when an employee experiences an injury or illness as a result of work.
The first step in the workers’ comp claims process is for an employee to report their work-related injury or illness to you. Your state may require that they do so in writing. You or your employee should check with your state’s workers’ comp agency, or seek legal counsel, to find out if there is an official form your employee should use when reporting an injury to you. If there is no official form that employees are required to use when reporting an injury to an employer, they can choose the method that best suits them (email, letter, text, etc.), though some companies may also have their own standardized form
State laws often require employees to report their occupational injuries or illnesses within a set timeframe to qualify for workers’ compensation benefits.1 For example, in New York, employees must report injuries from occupational accidents within 30 days and occupational illnesses within two years of knowing the illness is work-related.2 So it’s important that your employees are trained to notify you promptly of any injuries or illnesses.
Once you hear of an incident, you need to provide the employee with the official workers’ comp claim form so they can report it. The form will be available from the main workers’ comp authority in your state.
In many states, providing this form to your employee must be done within a specified timeframe. For example, in California, employers have one working day to give or mail an employee a workers’ comp claim form once the employer is notified.3 In some states, you may also need to provide employees with information about their workers’ comp rights and benefits.
Employees then fill out their section of the form, sign it, and give it back to you. This form often documents information such as the date and time of the incident, details of what happened, names of witnesses, emergency treatment details, and more.
Once you receive the workers’ comp claim form back from your employee, fill out the employer’s section. It will document information such as your contact information, the cause of the incident, the worker’s weekly wage, and the date you learned about the claim.
When finished, you’ll need to keep a copy, give a copy to the employee, and send a copy to your workers’ comp insurance provider. Often, this step must also be done within a specified time period. For example, in Oregon, employers have five days.4 Check your state’s workers’ comp board or department of insurance to find out the specific requirements that apply to you, and seek legal counsel or speak with a qualified insurance agent or broker.
In some cases, the Occupational Safety and Health Administration (OSHA) will also need to be contacted. For example, all employers in OSHA jurisdictions must report fatalities and catastrophic events to OSHA within eight hours. You must also report in-patient hospitalizations and any other catastrophic injuries or losses within 24 hours.5
Further, depending on your state’s laws, you may need to report the injury to your state’s workers’ comp authority.
After you have filed the claim with your insurer, you and your employee will have to wait for an answer. Insurers have a set amount of time to accept or deny a claim, which again varies by state. For example, in California, insurance companies have 14 days to respond and 90 days to make a final decision.6
Once a decision is made, it will be delivered in writing. If the claim is accepted, the payment details will be included, which can then be accepted or negotiated by the employee. If the workers’ comp claim is denied, a letter will be sent explaining the reasons why as well as how the employee can file an appeal.
When an employee recovers and is cleared to go back to work by their doctor, a medical work and status form will often be sent to you and your workers’ comp insurance provider.7 It will likely outline the current functional capabilities of the employee. Then, you can then assess the situation to determine how to ramp them back up to speed and if their duties need to be adjusted due to any changes in ability.
Note that companies allowed by their state to self-insure must manage the entire workers’ comp claims process on their own. Some companies that are self-insured choose to work with a third-party administrator to manage the claims process.
As an employer, be aware that there may be additional requirements in your state. To find out, look up your state’s authority on workers’ comp, speak to a lawyer and insurance agent and/or broker .
Employers are often asked for a variety of information when filing a workers’ comp claim. This will include the following:
Remember, this is a general list. To find the exact information you’ll need, consult your state’s workers’ compensation claim form or a legal and insurance expert.
The length of time that workers’ comp insurance companies have to accept or deny claims varies depending on the state. In most cases, insurers must give you an update within two weeks to a month.
However, this may not be an acceptance or denial, but a notification that they need more time to investigate. Investigations can take from 90 days up to six months, depending on the state.8,9
Getting wind of a new workers’ comp claim is never good news. You worry about your employee and may be confused about what comes next. But once you understand the process, it will be much less stressful. Just be sure you look up the rules and deadlines in your state so you can meet all of your obligations. Then, you can file the paperwork and help your employees get the care they need to get back to business as usual.
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