The Complete Best Guide to Workers Compensation Insurance Claim Process

TLTR: This article discusses the workers compensation claim process, who qualifies for it, and addresses things that can go wrong during the process. It also discusses the role of a legal attorney while filing a claim process and answers some frequently asked questions.  

“We have a progressive and humane system of workers’ compensation insurance in this state. It is one of the jewels of American civilization.”— Louis D. Brandeis, U.S. Supreme Court Justice (1916) 

In this blog

What is Workers Compensation Insurance?

According to a study conducted by Statista, there are about 127 million full-time employees in the country. Workers compensation insurance is mandatory for employers who have more than three* employees.  

Workers compensation coverage is designed to protect workers from being fired or having their wages reduced for reporting injuries on the job. In exchange for having this protection, workers cannot sue their employers for work-related injuries. 

Employers need to pay a percentage of the wages as compensation to injured workers. This compensation is usually paid when a worker files a worker’s compensation claim. The payment is through; either directly by the employer or through contributions into a state fund.

*While workers compensation insurance is mandatory as a federal law, the regulation depends according to state. The number of employees may vary.

Workers Compensation Claim –A Brief Understanding

The process of filing a workers compensation insurance claim is not an easy one. It takes time, patience, and knowledge before you can get the benefits that you deserve.  

According to AFL-CIO, workplace hazards kill and disable more than 100,000 workers each year. While the Occupational Safety and Health Act (OSHA) helps save thousands of lives, knowing your way around the claim process can be tricky. Many people fail to act as required when filing for a workers compensation claim. They may end up settling for an offer which barely covers their losses.  

The first thing to decide after serious injury or illness on the job is whether or not it’s worth filing a claim at all. It doesn’t come without some disadvantages. An average worker may face issues such as; inevitable costs and lack of proper legal representation, among many more.  Employees often don’t know how best to navigate the workers compensation insurance claim process without help. 

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How To Get Started On Your Workers Compensation Claim Process?

It’s your typical Tuesday morning at work. You spend a few minutes at your desk checking your email, then you get up and go to the breakroom to get a cup of coffee. Unfortunately, you don’t notice the puddle of spilled orange juice someone left on the floor next to the coffee machine. You slip and take a bad fall. Now you have a broken wrist. You can’t type and therefore you can’t work for a few of weeks. This is how you get started on your workers compensation claim process:  

Step One: Report the Injury To Your Employer As Soon As You Can

Report the injury ASAP. Do not wait more than seven days from the date of the injury to report it. If you do, your claim may be denied.  

Step Two: Fill Out And Submit Paperwork

Your employer will provide you with information on your rights and compensation benefits. They will also provide you with a workers compensation claim form. Fill it out and return it to your employer.  

Note: Most companies include the form and information regarding your rights in the new hire employment packet. If you haven’t been notified about your rights prior to the accident, your employer has left themselves open to a potential lawsuit.

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Step Three: Your Employer Reports The Accident and Files The Claim

Your employer or the representing party of the company is responsible for filing the claim with the insurance company. They will also need to submit your medical report.  

While your employer is tasked with managing most of the official work for your workers compensation claim process, you may have to report your injury to your state’s division of workers compensation board. Check with your employer for details on this particular process.

Step Four: Your Claim Is Either Approved or Denied

After filing your claim, the insurance company will either approve or deny it. Once they’ve reached their decision, the insurance company will contact your employers, who will notify you.  

Once approved:  

  • Make sure to ask any questions you might have about the amount you’re being compensated for.  
  • Only accept the offer if you are satisfied with what is being presented to you.  
  • Remember that you can get legal help if you’re not satisfied with the offer you’re given.  
  • Negotiate for a lump-sum settlement or a larger structured settlement, if you like.  

If denied:  

  • Request a reconsideration from the insurance company.  
  • File a formal appeal via the worker’s compensation claim board.  
  • Get legal advice and involve an attorney if necessary.

Step Five: Returning To Work

Once you have recovered from the accident, make sure you provide a notice to both your employer as well as the insurance company. The latter because if you have a permanent disability due to the accident, they may need to give you further benefits.  

You will have to inform both the parties, regardless of your health status.  

Information Required To File A Workers Compensation Claim 

To start your claims process, workers compensation insurance companies require a lot of information. Here’s a list of everything you’ll need:  

  • Personal details (name, address, age, phone number, and more) 
  • Private bank account number and location code 
  • Parent company name 
  • Insurance policy number 
  • Social security number
  • Hire date 
  • Current wage structure 
  • Date of injury incident 
  • Date of diagnosis/ doctor’s check up 
  • Type of injury 
  • Injured body part
  • Witness information (if any) 
  • Cause of accident 
  • Name of the place where you received medical treatment  
  • Number of days you received treatment  
  • Anticipated return date 

Note: Reach out to your employer and/or insurance company to see if they require any additional documents besides those mentioned above.

Who Can File Workers Compensation Claim?

Most employees who are injured on the job can submit a workers compensation claim. But certain conditions must be in place:  

  • You must be an employee at the given company. 
  • Your employer must carry workers compensation insurance.  
  • The injury must be due to a work-related accident.  
  • You must meet your company’s as well the state’s deadline to report the injury and file the workers compensation claim.  

Some occupations are more hazardous than others. According to the Bureau of Labor Statistics, these jobs have the most workplace injuries:  

  • Nursing assistants 
  • Heavy tractor-trailer truck drivers 
  • Laborers and freight, stock, and material movers 
  • Light truck drivers 
  • Construction workers 
  • Maintenance and repair workers 
  • Stockers and order fillers 
  • Janitors and cleaners 
  • Registered nurses 
  • Retail salespersons 

What Does Workers Compensation Insurance Cover?

Workers compensation insurance covers fatal as well as non-fatal injuries for employees who have accidents at work. Specific coverage includes: 

  • Wage replacement benefits 
  • Medical treatment 
  • Vocational rehabilitation 
  • Ongoing care 
  • Funeral costs 
  • Disability benefits 
  • Other benefits 

You Can’t File A Workers Compensation
Claim For

These include:  

  • Stress 
  • Psychiatric Injuries 
  • Self-inflicted Injuries 
  • Injuries caused due to fights 
  • Accidents while commuting 
  • Injuries caused while committing a crime 

What Types Of Injuries Does Workers Compensation Insurance Cover? 

As reported by Nolo, you can only be eligible for a workers compensation claim if your injury/illness is directly connected to your work. They call it AOE/COE (arising out of employment and occurring during the course of employment).  

Here are the types of injuries which are covered by the policy:  

  • Temporary total disability (For example: fractured limbs) 
  • Temporary partial disability (For example: neck fracture) 
  • Permanent total disability (For example: loss of sight) 
  • Permanent partial disability (For example: loss of sound in one ear) 

According to Injury Facts, the leading causes of non-fatal work-related injuries are:  

  • Overexertion 
  • Bodily reaction 
  • Slips 
  • Trips 
  • Falls 
  • Contact with objects and equipment 
    when-you-should-know-about-car-insurance-for-new-drivers

    Some Policies That Cover Workers Compensation Insurance

    There are many policies in the United States that offer coverage for workers compensation insurance. Each industry has its own insurance policy which covers its particular needs. Below is a list of the different types of insurance policies that might be considered when evaluating workers compensation:

    Farm Insurance

    Farm insurance doesn’t only insure farming equipment and livestock. There are some companies that offer farm insurance policies which will cover workers compensation. 

    Food Truck Insurance

    Food trucks are becoming an increasingly popular business venture.  Food truck owners should be aware that if they have employees working for them, they will have to pay for workers compensation insurance. Their food truck insurance coverage generally covers their workers, too. 

    Nursing Insurance

    Nursing insurance policies are designed to provide protection for anyone working within the medical field.

    General Contractor Insurance

    General contractor insurance covers all types of builders and construction workers.

    Professional Liability Insurance

    Professional liability insurance is a type of policy that protects businesses from all types of claims. It can cover workers compensation as well. 

    Business Owners Policy (BOP)

    Almost every business owner has a BOP included in their business plan. The policy is uniquely designed to cover all aspects of a business, including workers compensation.

    Conclusion

    Your employer is legally obligated to pay you workers’ compensation benefits if an injury occurs at work that’s not related to an accepted job risk (i.e., something that has always been a known threat present in the workplace). However, it may be up for debate whether you’re entitled to additional money stemming from an off-the-job accident during lunch break or coming to and from work. 

    But what about when you’re using a company vehicle for work purposes? Are you still entitled to collect benefits even if an accident occurs in the course of your daily commute while carrying out your company’s tasks? The answer is yes—so long as you can prove that this is an established job requirement.  

    If you’re looking for a workers compensation insurance quote or have more questions about the workers compensation claim process, feel free to get in touch with a local insurance agent.

    Frequently Asked Questions (FAQs)

    What's The Difference Between An Employer-Provided Doctor And A Private Physician?

    Employers are required by law to offer their injured workers medical treatment through company doctors. If that physician determines that you don’t need further attention, he/she will sign off on the paperwork needed to submit official injury status with the Workplace Safety and Health Division (WSHD). 

    Why Should You Hire A Workers Compensation Attorney In The First Place?

    Workers compensation attorneys help you to get your Worker‘s compensation benefits quickly and easily. It doesn’t matter if you have just been injured or are still suffering from the effects of past injuries, their main goal is to ensure that you receive all the benefits that you deserve from your employer according to law.

    Are Part Time Employees Eligible For Workers Compensation Insurance?

    There’s a common misconception that part-time employees can’t receive workers compensation insurance. This is not true. Part-time employees can be eligible for workers compensation insurance benefits. As long as the employee’s pay is deducted for taxes, they are eligible to receive workers compensation insurance.

    Why Do Some People Get Lawyers To Handle Their Claim Processes?

    In some cases, an employee is likely to face an uphill battle in the process of filing a workers compensation claim. The workers compensation insurance company may employ professionals who try to deny or prevent you from receiving any compensation, so it’s important that you find someone with experience and resources to support your interests. 

    How Much Does Workers Compensation Insurance For Small Business cost?

    According to Coverwallet, workers compensation insurance for a small business owner who only has a few employees will cost between $2,000 to $3,000 yearly.  

    Which State Has The Best Workers Compensation Insurance Policy?

    You already know that workers compensation is mandatory in every state. However, some states regulate the policy better than others. The best states in terms of higher rates for workers compensation insurance policy are Alaska, Montana, California, Hawaii, South Carolina, and Idaho.

    Do I Need Workers Compensation Insurance For Household Employees?

    Generally, there is no legal requirement for this. But yes, you should get workers compensation insurance for household employees such as a nanny, butler, chef, cleaning person, gardener, and so on. However, you will need to check with your insurance company to see how much coverage you will be required to provide for them.

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