How Does the Workers’ Compensation Claim Process Work?

How Does the Workers’ Compensation Claim Process Work?

Whenever employees have work-related injuries or illness, the Workers’ Compensation Insurance helps them cover the costs and receive rightful compensation in case of negligence. It helps cover expenses such as lost wages and medical costs of sick or injured employees. The plan also aims to protect both the employees and the employer, promote their safety, and help employees get back to work.

However, both parties need to follow a particular process to ensure fairness in the claim. Insurance claim processes can be difficult to navigate and hiring Brian Patten Associates to manage your employee solutions may prove to be the best option.  Even though the compensation claim process may vary slightly from state to state, the following are the necessary steps:

Train and educate employees

Not many people read the thick employee handbook provided at the start of employment. However, knowing about how the workers’ compensation claim process works is essential for both parties. To receive the benefits, the employee must know how and when to apply for a claim and the requirements. Regardless, it is the employer’s responsibility to offer supervision and training to employees on reporting an injury. Employers also need to educate employees on the company policy regarding occupational health and hazards. For instance, employees must know that occupational diseases such as mesothelioma caused by asbestos exposure also count as workplace injury in addition to physical damage. In such a case, employees can seek legal assistance to hold the employer accountable for treatment.

Notify the employer of your injury

The first official step in filing a Workers’ Compensation Claim is to report the injury to your employer or supervisor as soon as it occurs. The injury must be work-related and can include cumulative trauma, acute injuries, and occupational diseases. The employee should report the nature and extent of the damage to the supervisor. However, in case of medical emergencies, the employee must first be given immediate medical treatment. If the injury is not severe, the employee can see a specific doctor covered by the workers’ compensation policy. Additionally, by visiting the doctor as soon as possible, the employee can receive the necessary documents and medical reports required to file a claim.

The employee must provide a complete illness/injury report

This step can be carried out in different ways depending on the company’s policy. For instance, some employers may ask the injured employee to provide a complete injury report. In contrast, some companies may only require the employee’s assistance in completing the report while creating one on their own or relying on forms provided by the state’s workers’ compensation agency. The injury report typically consists of information such as the description of the incident or the injury, date, time, location, etc. Alongside the report, the employer must also provide the employee with all the necessary paperwork such as reporting forms, information about their rights, etc.

File the claim for injury

After the affected employee has turned over all the official paperwork to the employer, the employer files the claim with their workers’ compensation insurance provider and the state workers’ compensation board. The employee’s doctor will also provide medical reports and documentation regarding the employee’s injuries to the insurer. Before filing for a claim, ensure you understand the grounds on which the claim can be rightfully denied or approved. Once the claim has been filed, the insurance company will now evaluate the paperwork and the compensation due.

Wait for the insurer to approve the claim

There is no standard timeline for how long insurance companies can take to evaluate workers’ compensation claims. Typically, the company will assess the claim based on its policies and notify the employer whether it has been denied or approved. For instance, workers’ compensation doesn’t typically cover injuries while fighting, commuting to and from work, and self-inflicted wounds. Once the insurer approves the claim, it will contact the employer and employee with payment details. However, suppose the insurance company denies the claim. In that case, the employee can appeal or ask the insurance company to review the decision. The insurance provider will also notify the workers’ compensation board in any instance about their decision.

Preparing to return to work

Once the employee has recovered from the injuries, she/he will need to notify both the insurance provider and the employer via written notice of their return to work. Depending on the longevity and the severity of the injury, the insurance company may or may not continue to pay benefits to the employee. Furthermore, there is a chance of an increase in the company’s workers’ compensation premiums if the employee continues to incur injuries at the job.


Employers should strongly consider purchasing workers’ compensation insurance policies as soon as they start hiring. This is because it protects both the employee and employer legally and saves the employer from paying hefty medical bills. It is also a way to cover the employee’s medical expenses and lost wages. Insurance coverage is a benefit them many individuals seek nowadays while looking for jobs. And responsible employers do everything within their limits to provide their workforce with a safe and healthy workplace.

One thought on “How Does the Workers’ Compensation Claim Process Work?

Leave a Reply

Your email address will not be published. Required fields are marked *