Workers' compensation claim process for businesses

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 claim process rolling, you’ll need to:

• Give your employee the appropriate paperwork to fill out regarding the date, time, place, and circumstances of the injury.
• Interview witnesses as appropriate and include their statements in your supporting documentation for the claim.
• File the completed form and supporting claim documentation with your insurer.
• Submit a first report of injury form to your state’s workers’ compensation board if required.

Workers’ compensation laws vary by state, so be sure to check your state’s rules and deadlines to assure you’re in compliance.

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:

• Accept the insurance company’s payment offer, which may cover the costs of medical bills, medicine, disability payments, and a portion of lost wages.
• Negotiate for a lump-sum settlement or larger structured settlement.

If a claim is denied:

If your workers’ comp insurer denies benefits, the employee has the option to:

• Request a reconsideration from the insurance carrier.
• File a formal appeal, usually through the state workers’ comp board or commission.

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.

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:

• You have an active workers’ compensation policy.
• The injured worker is an eligible employee of your business.
• Your employee became injured while at work or became ill due to work conditions.

• Stress or other psychiatric injuries
• Self-inflicted injuries
• Injuries caused by fighting or horseplay
• Injuries that happen while commuting to or from work
• Injuries sustained while committing a crime, under the influence of drugs or alcohol, or while violating company policies

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:

• Do provide employees with accurate information on their rights and benefits.
• Do report any injuries in accordance with state deadlines.
• Do accurately classify employees and injuries.
• Don’t attempt to influence a medical provider’s diagnosis or treatment.
• Don’t appeal an approved claim without probable cause.

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.