How to File a Workers’ Comp Claim
When your worker gets injured during work, you have a limited time to complete the paperwork. Otherwise, your employee will miss their MD Workers’ Comp benefits. But, how do you file a claim? Here’s a step-by-step process.
Reporting Employee’s Injury
The employee has the responsibility to report an injury. These injuries must relate to work and happen during work.
An injury can be as simple as slipping on an icy parking path or developing a serious illness due to exposure to hazardous substances. However, before reporting an injury, co-workers or other people should rush your employee to a hospital if the injuries are severe.
If it’s minor or scratches, an injured employee should visit a doctor/physician at the soonest possible time. The diagnosis and medical report are important documentary requirements. Often, the doctor or physician is part of the insurance provider’s network.
The notice should be in written form, and the deadline for giving notice varies. In some states, your employee has 30 days. Others will give employees up to two years to report.
In cases of illnesses, the first symptoms or diagnosis could be the basis of reporting an injury.
Submission of Forms
You, as the employer, must submit the necessary forms for claiming. Moreover, you should provide the forms, which include:
- reporting forms for the insurer
- Reporting forms for the board of the state worker’s comp
- List of rights and benefits
- Details on how to return to work
- Any other relevant information.
The forms depend on the insurer and the state board, and the injured employees must accomplish these forms, honestly.
However, the most important part of this step is disseminating the information. This information should include the worker’s comp benefits your employee can get during work-related accidents.
You can include this information in your employment contract. Discuss it in orientation or before an employee seeks treatment. Failure to provide the essential information will expose you to litigation risks.
Filing a Claim
Filing a claim for worker’s comp benefits is your responsibility as an employer. You submit the forms to the insurer, along with the medical report. Alternatively, your employee can mail the diagnosis report to the insurer.
Aside from the insurer, you need to submit the same documents to the state board on worker’s comp. Even if your employees aren’t claiming, your state may require you to submit all work-related injuries.
Approval or Denial
Now, all you need is to wait for the decision of the insurer. If approved, the insurance provider will contact your employee and ask for payment details.
Everything after the submission of documents is between your employee (and his/her legal adviser), the insurer, and doctors/physician. However, an insurer denies a claim.
What could be the reasons for the denial of claims? One, injuries are unwitnessed. Insurers don’t like this. So, as much as possible, your employee must provide a piece of evidence or another witness to create a credible claim.
Two, the insurer might deny a claim if they find discrepancies between the accident report and initial medical diagnosis. Moreover, the presence of illegal substances in your employee’s blood test is a possible cause.
Lastly, the employee refuses to do his/her obligation during the treatment. Yes, your employee and his/her doctor should provide detailed information during treatment.
Alternatively, the employee can sign an authorization to give limited authority to the insurer. This authority includes requesting detailed medical bills, among others.
When an insurance provider denies a claim, they must inform the state board of Worker’s comp about the decision.
Return to Work
After treatment, the employee can now notify you and the insurer about his/her intention to return to work. This notification is in writing.
If the employee suffers a disability, he/she can receive disability benefits (depending on the coverage, inclusions, and exclusions). You may ask your provider about the disability insurance.
A claim on worker’s compensation increases your next premium payments. So, avoid this by strengthening your safety and health policy. Provide training and create a safe work environment.
Conclusion
In claiming a worker’s comp benefit, your biggest enemy is time. Remember, some states have shorter reporting periods. The shortest could be 30 days.
So, you should set the procedure of reporting accidents and injuries in the workplace. Your employees must know what they need during this time. Also, appropriate risk management is equally important.
If you haven’t availed of a worker’s compensation, talk to a provider now to avoid getting fined.
About Moody Insurance Worldwide
Moody Insurance Worldwide, a division of Moody & Associates that was founded in 1914, is a leading provider of risk management programs and insurance coverage to individuals and businesses across the East Coast. We write all sizes of businesses, with technical expertise in many key industry areas, and provide personal insurance programs for estates and high net worth individuals. Our licensed, experienced commercial account managers can work with you to determine the coverage that you need at a competitive rate. Contact us today at (855) 868-0170 to learn more about what we can do for you.