How to Claim Worker's Compensation Insurance? | Steps & Checklist

A worker's compensation insurance is construction insurance that helps to cover medical expenses or lost wages when the employee is injured or sick. An employee who has experienced injury or illness due to the current working environment or current job should file for worker's compensation. This includes incidence like workplace accidents/illnesses caused due to workplace situations.

Photo by Dean Bennett

Prodyogi discusses the main steps to be followed to claim worker's compensation insurance along with the things to remember and the checklist followed before claiming a worker's compensation. 

Things to Remember Before Claiming Worker's Compensation Insurance

Before an employee decides to claim worker's comp, there are certain parameters that one must make sure:
  1. Make sure that the current company has worker's compensation insurance.
  2. You are an official employee of the company.
  3. Be sure that the injury is caused while on the job.
  4. Make sure not to claim if the injury is caused due to the following reasons:
    1. Injuries are caused when employees perform activities against the company policy.
    2. Injuries caused due to Psychiatric conditions.
    3. Accidents that occur on the commute to or from work. 

How to Claim Worker's Compensation Insurance?

The basic steps involved in filing worker's compensation insurance are illustrated in the flowchart.

1. Report the Incident to the Employer

Employees who experience injury or accidents have to report the incident to the employee as quickly as possible. The deadline for reporting the incident varies by state and it is usually between 30 and 45 days.

An Incident report to claim a worker's comp must include the following details:
a. Date of Injury
b. Type of Injury Sustained
c. How & Where the Injury Sustained

Irrespective of any specifics of the incident, it should be reported immediately to the employer quickly as possible. The incident needs to be reported either to the designated in charge of the human resource department or the safety representative of the company. 
The Occupational Health and Safety Administration (OSHA) requires employers to report a fatality within 8 hours and any amputations, loss of an eye, or inpatient hospitalizations within 24 hours.

2. Employees Seek Medical Treatment

Depending on the severity of the injury, the employee must seek medical treatment or take necessary first aid immediately. Always prioritize the health of the employee.
Based on the state, employees must undergo an evaluation by an approved medical provider of the employer's choosing. 

3. Prepare and Submit the Paperwork

Once the employee reports the injury and receives the required treatment, the employer prepares a few papers works, an application, and supporting medical reports of the treatment to claim worker's comp insurance. 
Usually, the employer is asked to submit the following information for claiming worker's comp insurance:
  • Employee Information
  • Employee Job Information
  • Employer Information
  • Injury Information
  • Medical Care Information
  • Work Information
The employer is responsible for providing all the related forms to be filled out by the insurance provider and state worker's compensation board. They should inform the employee of the related rights and benefits under worker's compensation law and information regarding returning back to work. 

4. Employer Reports the Injury and Files the Claim

The employer is responsible for submitting or sending the claim form and supporting documents to the worker's comp insurance carrier. 
As in Chicago, any workplace injury needs to be reported to the state's division of worker's compensation or worker's comp board. This is mandatory if the employee has worker's comp benefits or not. 

5. Insurer Approves or Denies the Claim

Insurer Approves the Claim

If the insurer approves the claim, the employer is informed and made employee know about the payment details. At this point, the employee can either:
  • Accept the insurance company payment offer. This offer would cover the cost of medical bills, medicine, disability payments, and a portion of the lost wages.
  • Negotiate for a lump-sum settlement or larger structured settlement.

Insurer Denies the Claim

If a worker's comp insurer denies benefits, the employee can either:
  • Request a reconsideration from the insurance carrier
  • File a formal appeal, usually through the state worker's comp board or commission.

6. Employee Returns to Work

Once the employee recovers from an injury, he must provide a written notice to both their employer and the insurer on the date of rejoining. Depending on the severity of the injury, the insurance company may receive permanent disability benefits. 

Worker's compensation insurance specifically mentions all the injuries that are covered or not covered which are merely dependent on the state or country laws.