Worker™s compensation is a special insurance required for
employers in most states. While the laws vary between states and sometimes industries,
worker™s compensation is designed to protect both employers and the employees
who work for them. A severe workplace injury can be financially devastating for
both the business and the employee who must endure the pain of the injury.
If you are unfamiliar with the insurance claims process, it
can seem overwhelming. However, support from your insurance carrier, along with
your state guidelines, can help guide you through the experience. It is
important to be compliant with state and federal laws regarding worker™s
compensation insurance. This will also help guide you through the insurance
claims process as smoothly and quickly as possible. Here™s what you need to
know about worker™s compensation claims.
Different in Each State
While the specific process may vary in each state, the
general guidelines are the same. States may differ on the specific forms which
must be initially submitted and the amount of time allotted to do so. For
instance, some states allow injured employees 1 year to file a
worker™s compensation claim, while others allow 2 years. Some states may
require all businesses with a single employee to carry worker™s compensation
insurance, while others may require businesses with more than 4 employees to
carry it. You should check on the requirements of your specific state to ensure
your business is compliant.
Initial Steps
The first and most important step in the insurance claims process is to get the injured worker immediate medical help. Their health
is the most important element, so you should advise them to seek medical
attention immediately after an injury. If there are specific network requirements
for physicians or medical pharmacies, then it is the employer™s responsibility
to ensure employees are aware of those requirements.
Some injuries don™t always manifest symptoms immediately
which is why some states have a longer reporting limit. Even if the injured
worker feels fine immediately following the accident, encourage them to seek
medical attention. Should the need for treatment arise in the future, detailed
and accurate records will help ensure they get what they need to heal appropriately.
Reporting and Claims
Injured employees should report the accident and injury in
writing to their supervisor as soon as they are able. This helps ensure claims
can be paid in a timely manner. Not all states require written notification, but
it™s always a good idea to prevent discrepancies. Once written notification has
been received by the employer, then the official claims process can begin.
The employer will likely have accident forms and other documentation for the
injured worker to fill out, giving a detailed description of the accident and
injuries. Employees should receive a copy of any form relating to their
on-the-job injury, and employers should notify their insurance carrier
immediately. The insurance carrier will then request supporting documentation
from the medical provider before notifying the claimant and employer of claim
approval or denial.
Don™t Wait to Report
Prompt reporting is essential to getting claims paid in a
timely fashion. It is also necessary to ensure the injured worker receives
adequate and appropriate medical treatment for their injuries. Supporting
documentation can help ensure the injured worker gets access to the needed care
along with missed wages due to healing while helping to keep rates low for
employers. Immediate reporting is also key to faster healing and a safer
workplace for everyone. If someone has been injured in a workplace accident,
don™t wait to report it. Get medical treatment immediately, report it to the
supervisor, and fill out the appropriate paperwork for the sake of all
involved.
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