Experiencing a work-related injury can be a stressful experience for everyone involved, but knowing how to navigate the workers’ compensation process can take some of the pressure off. Although the injured worker needs to fill out a claim form themselves, it’s your responsibility as an employer to guide them through the claims process.
Learn how to claim workers’ compensation with your insurance company and streamline the claims management process so you know what to do when an incident arises.
What Is a Workers’ Compensation Claim?
Workers’ comp, or workers’ compensation insurance, is a type of insurance policy that employers carry to cover their employees if they get injured in a workplace incident. In addition to medical care, it also covers lost wages so the injured employee can take home a portion of their average weekly wage while they recover.
Whether or not a business is required to offer workers’ compensation benefits varies from state to state, and the premium is calculated per $100 of total payroll. In some cases, large employers may be “self-insured” and provide workers compensation coverage themselves rather than through an insurance carrier.
Workers’ compensation insurance covers common workplace injuries, including:
- Acute injuries, such as a broken arm or another body part
- Repetitive strain injuries, such as tendonitis or trigger finger
- Occupational diseases caused by long-term exposure to hazards at work
It does not cover accidents caused by drug or alcohol impairment, self-inflicted injuries, or injuries sustained outside of work or after work hours.
Commuting isn’t typically covered, but incidents that take place on a business trip or errand, or in a company vehicle, might be eligible.
For minor injuries or those that don’t require immediate medical treatment, the injured employee may need to go to an in-network health care provider to ensure that their medical bills are covered by the employer’s insurance carrier.
How to Claim Workers’ Compensation
Submitting a claim in a timely and accurate manner can help avoid delays and increase the likelihood of a successful workers’ compensation case. Here are five steps to follow to help an employee claim workers’ compensation:
1. Document Incidents Promptly
Navigating the workers’ compensation system starts with knowing how to handle a work injury correctly. Serious injuries that require hospitalization need to be reported to the Occupational Safety & Health Administration (OSHA.gov) within 24 hours, but even minor incidents should be documented in case future medical needs arise.
You can use a cloud-based platform like Pulpstream to standardize and automate your incident management process. In some cases, you might need to interview witnesses and conduct a more detailed accident investigation before moving forward.
2. File a First Report of Injury With the State
In some states, you may need to file a first report of injury to your state’s Department of Labor or Division of Workers’ Compensation as part of the process. This requirement is time-sensitive, and may be as short as 10 days in some states.
For example, in New York, workers’ compensation law requires employers to notify the “Workers’ Compensation Board on or before the 18th day after the workplace injury or illness occurred, or within 10 days after the employer learns of the event.”
Keep in mind that this isn’t the deadline for the employee to report the injury to you. In New York, employees have up to 30 days to report a workplace incident before losing their right to a workers’ compensation claim. In other states, it’s even longer.
3. File a Claim With Your Insurance Carrier
In addition to meeting any state-specific requirements, you’ll need to submit a workers’ compensation claim to your insurance company. The injured employee will need to fill out a claim form with their phone number and other contact information, the date and description of the injury, and other relevant details.
Your human resources team should be available to help the claimant fill out the form accurately and submit the completed form to your insurance carrier.
4. Follow Up With the Employee
Your insurance carrier will notify the employee if the claim has been approved or denied, usually within a matter of weeks. If it’s approved, the injured worker can decide whether to accept the lost wages and medical benefits offered, or negotiate a settlement.
If the claim is denied, they can appeal the decision, either with the insurance company directly or through the state’s workers’ compensation department.
Either way, it’s important to check in with the employee throughout the process to see how their recovery is going and ask if there’s anything you can do to help.
5. Initiate the Return to Work Process
Injured employees typically can’t work while receiving workers’ compensation benefits — but they may be able to return to work sooner by taking on temporary or light-duty assignments. Getting back to work may speed up the recovery process and enable them to get back onto the payroll faster to receive their full salary or wages.
Of course, you’ll need to ensure that they’re medically able to do so. Their doctor can provide a fitness for duty certificate or a list of duties they can safely perform.
What If an Employee Isn't Eligible to Claim Workers’ Compensation?
There are some situations in which an employee may be out of work due to an injury or illness, but isn’t eligible for workers’ compensation at all. This may be the case when:
The employer doesn’t have a workers’ compensation policy. In some states, such as Texas, employers aren’t required to maintain workers’ compensation coverage, but they must ensure that employees know about the absence of coverage. Employees may be entitled to sue in the event of a workplace injury.
The injured worker isn’t an employee. Only workers who are classified as employees can claim workers’ compensation. This means that freelancers, contractors, and some part-time workers may not be eligible for benefits. Federal employees have their own workers’ compensation program administered by the U.S. Department of Labor.
The type of injury or illness isn’t covered. Workers’ compensation is only available for on-the-job injuries and occupational illnesses. Other issues, such as mental health conditions, aren’t covered, even if they’re due to poor working conditions.
Alternatives to Claiming Workers’ Compensation
Employees who aren’t eligible to claim workers’ compensation may still be entitled to receive other benefits, such as short- or long-term disability insurance, or a leave of absence under state or federal leave law.
The Family and Medical Leave Act (FMLA) provides up to 12 weeks of unpaid leave for some qualifying situations, including chronic mental health conditions and injuries that take place outside of work. It covers most employers with at least 50 employees.
The Americans with Disabilities Act (ADA) may also apply if an employee’s workplace injury results in a disability. Employers are required to engage in the ADA interactive process to provide suitable accommodations to eligible employees.
Streamline Claims and Incident Management With Pulpstream
Whenever an employee has a work-related injury, the last thing anyone wants is to deal with tedious and time-consuming paperwork. But since every state has its own incident reporting requirements, it’s important to keep accurate records of what happened and file a timely workers’ compensation claim with your insurance provider.
Pulpstream helps you navigate it all with our cloud-based claims management platform. Streamline your claims management process with integrated insurer communications, OSHA report generation, accommodations and return to work tracking, and more.
Request a demo today to see how Pulpstream can assist your HR team!
