How do I file a Workers’ Compensation Insurance claim?

How do I file a Workers' Compensation Insurance claim?

Workers’ Compensation policy is a boon for business owners as it helps them safeguard their workers’ health and wellbeing. In lieu of minimal premiums, you get cover for the worker’s medical care, wages, and more. And the best part, it is effortless to claim your insurance. That’s why this article will educate you on how to file a Workers’ Compensation Insurance claim!

But before we start, let’s see what a claim can fetch you!


What is a Workers’ Compensation Insurance claim?

Workers’ compensation insurance policy enables business owners to take care of their workers if they get hurt or worse while at work.

And a claim can help business owners provide medical care, lost wages, and rehabilitation cover to their workers in case of injury or illness. This policy also covers the owner and the employee’s family if an employee dies due to injury or illness related to work.

This policy is also popularly called workers’ comp insurance.


How to decide the cost of Workers’ Compensation Insurance?

Workers’ compensation insurance rules are different for every state. Thus it is difficult to determine the exact cost. But factors like the size of the workforce, risk in business, annual payroll, type of operations, claims history and location of companies, etc., are considered for calculating the cost of insurance.    

To calculate the premium, use the below-mentioned formula:

Classification rate x Experience modification factor x (Payroll $100) = Premium

Apart from this calculation technique, workers’ compensation premium is determined as per the National Council on Compensation Insurance guidelines. 


How does this insurance policy work?

This policy is a boon to business owners and their employees.  The policy assures employees with medical care in case of accidents and thus, gives them the confidence to give their best, thus improving their work quality. Similarly, businesses enjoy more liberty as the risks related to employees are covered under insurance.  

Example: A worker in your company gets injured while performing his job and needs medical help as soon as possible. Now, since you have a Workers’ Compensation policy, the employee receives treatment quickly and gets quickly cured. Since you had a workers’ compensation policy, the insurance company will cover all the medical costs.  


Which diseases or injuries do not qualify for Workers’ Compensation Insurance?

This insurance policy covers all the major critical diseases and conditions. But there is a list of situations where it is not applicable. They are listed below, as it is good to know what you are signing up for before entering into a contract.

  1. Illness that happens only once, like cold or headaches
  2. Heart attacks
  3. Mental trauma or other psychological issues
  4. Medical conditions which employee was facing even before joining the company
  5. Injuries that don’t happen at work
  6. Deliberate effort to hurt self or other
  7. Injuries arising from being intoxicated
  8. Injuries arising from the use of illegal drugs
  9. Injuries that happen due to committing criminal acts
  10. Injuries occurring at the time of employee’s act of violating company policy
  11. Wounds that can be cured with first aid
  12. Injuries due to employee’s horseplay
  13. Injuries suffered at the time of traveling to work from home and vice-versa
  14. Injuries of ex-employees


How Do I File A Workers’ Compensation Insurance Claim?


Step #1: Inform The Employer About The Injury

The claim filing process begins with reporting the issue to the employer. When an employee gets injured or gets sick at work, the employer must be informed in writing. Note, a further decision is taken depending upon the severity of the injury. At times, urgent treatment is needed, while other times, a doctor’s visit is mandatory for diagnosis.

Prolonged diseases like mesothelioma, carpal tunnel syndrome, tendonitis, back pain, etc., should be reported as soon as possible. Some states and insurers don’t quickly provide medical benefits for non-emergency conditions. In fact, there are deadlines for informing injuries.


Step #2: Employer should assist in documentation

As soon as an employer gets the report of the employee’s injury, he should inform the employee about all the insurance policy benefits.

Next, he should provide a claim form to the employee. And the employee needs to fill this form and provide all the required details about the cause & kind of injury, date, time, location and witness information, etc.


Step #3: Report the injury of the employee

The employer takes the next step in the process of filing the claim.

The employer sends the claim form and other essential documents to the insurer. The doctor’s report is mandatory to get approval for the claim. You also need to submit the first report of injury and the claim form to the insurance board. When A Small Business Needs Workers’ Compensation Insurance?


Step #4: Insurer Processes the Claim

Soon after the workers’ compensation claim has been filed, the decision to approve the claim lies with the insurer. He may or may not agree with the report.

The insurance provider starts an investigation to check the authenticity of the claim. Everything is reviewed in this investigation, from the eyewitness to the accident spot, documents, and other elements.  

Next, there are two scenarios. When the claim gets approval, both the employee and employer receive an offer. In this offer, the insurance company shares the approved claim amount. This is the time for negotiations on the claim amount.

Also, if the insurer refuses the claim, an appeal for reconsideration can be made by the employer.


Step #5: Help Employee to Return to Work

The employer must be informed when the employee recovers from the injury or illness and is ready to return to work. The employer should assist them in resuming their duties. At times, employers may even need to modify workers’ job responsibilities.

If training can help an injured employee then training sessions are also organized.


In A Nutshell…

Even one employee strong businesses are expected to own a workers’ comp insurance policy. Also, the process of filing a workers’ compensation insurance claim varies from state to state, so it would help to stay updated with the rules.

Workers’ Compensation insurance policy gives much-needed confidence to your employees and makes them give their best to your company. And ideally, it is their right too.

I wrap up this article on how to file a workers’ compensation insurance claim with this thought. I hope the content was helpful and solved your queries. And if you have any doubts or suggestions, please drop them in the comments box. I am all ears!