How to file a workers’ comp claim

Posted in Business

As a business owner, workers’ compensation is essential, but also something you hope you never have to rely on.

By definition, this coverage provides financial protection to a business and its employees for costs associated with injuries and illnesses that employees acquire while acting within the “course and scope” of their work.

While this all may seem simple on paper, it gets a little trickier when it comes time to file a claim. You care about the financial stability of your business and, more importantly, you want to be sure your employee is all right. On top of this stress and worry, you may be navigating an insurance claim process that you’re not familiar with.

So first, take a deep breath… Then learn about the essential steps of a workers’ compensation claim below, so that when the time comes to take action, you can quickly and efficiently file a claim, keep your business financially stable and ensure that your employee has a swift recovery.

1. Make sure your employee gets proper care.
The very first thing you should do is take care of your employee and ensure that he or she receives the medical care that’s necessary. To help you find a physician that is experienced in handling work-related injuries, your insurance carrier may provide recommendations through a preferred network program. Be sure to ask your independent insurance agent if this type of resource is available to you.

2. Report the incident ASAP.
Delaying the claims process will only cause you issues down the road.

Report injuries as soon as they occur by completing a First Report of Injury form and submitting it to your insurance company.

It is essential to report injuries in a timely manner. Depending on the state where your business is located, failing to report your claim promptly could result in fines or penalties. Plus, you want your employee to get the best care possible. By delaying the claims process, you may lose the ability to determine where your employee receives treatment.

Delays are often caused by missing information in the First Report of Injury form, so be thorough in your reporting. Double-check all names, addresses, phone numbers and social security numbers.

Also, don’t be afraid to file a claim. Filing a claim is not an admission of fault. Through the claims process, your insurance carrier will determine if benefits are owed based on all the facts of the case and the applicable workers’ compensation statute.

3. Chat with your claims representative.
Soon after you report your claim, a representative from your insurance company will call to discuss it with you. Between filling out the first report and chatting with your claims representative, you’ll be asked to provide the following details:

  • The circumstances of the injury or illness
  • Employee contact information
  • Employee wage history
  • Employee claim history
  • Witness information

You will also need to provide your ability to accommodate potential work restrictions and tell the representative if there is “modified duty” work your injured employee could complete. Be sure to have job descriptions updated and readily available. If a doctor sets work restrictions, your insurance company will ask for this information.

4. Send additional information.
Following the conversation with your claims representative, gather and send your insurance company any additional information you have about the claim. This includes return to work slips, witness statements, prescription drug receipts and any paperwork regarding treatment. If there is video of the accident available, be sure to send that in as well.

Your claims representative will then submit all required paperwork and information to your state’s Bureau of Workers’ Compensation. Remember, the quicker you can collect all of this information, the easier your claims process will be.

5. Keep in touch.
It’s important to stay in contact with your insurance company. If there are any changes to the information you’ve reported, immediately contact your claims representative. It’s also important to keep in touch with your employee to let them know you are concerned about their recovery.

While these steps can help you navigate the claims process, workers’ compensation policies vary by state, so be sure to know your state’s regulations before a claim occurs. Check out your state’s workers’ compensation website or give your independent insurance agent a call to determine the policies for your state.

The coverages described in this article may not be available in all states. Please contact a local independent Grange agent for complete details on workers’ compensation coverages, additional benefits and discounts. If the policy coverage descriptions in this article conflict with the language in the policy, the language in the policy applies.


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