How to File a Workers' Compensation Claim

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As the boss, you know it's your responsibility to ensure your employees are covered by workers' compensation and that you file a claim promptly when an injury occurs. Filing a claim quickly sends a positive message to the injured employee that they are valued, and it can help prevent lawsuits and reduce claim costs.

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But what do you need to know about filing claims, and how do you go about it? Let's find out. 

What is the Employer's Responsibility When a Worker is Injured?

When an employee gets hurt on the job, you're expected to:

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• Ensure the worker gets appropriate medical treatment.
• Contact your insurance carrier or broker as soon as possible to let them know of the incident. 
• Complete a first report of injury form and file a claim for workers' compensation benefits.
• Thoroughly investigate the incident by gathering information from the injured employee, witnesses, records, and videos. 
• Implement safety measures to prevent similar incidents from happening again.

Don't Forget About OSHA

Before you get too busy with your workers' comp claim, ask yourself whether you need to notify OSHA of the accident. 

If your employee's injuries were serious enough to require hospitalization or amputation, or they lost an eye or even died, you'll have to report the injury. You have eight hours to report a death and 24 hours for other events.

How to File a Workers' Comp Claim in 6 Easy Steps

Below is the general process for filing a workers' comp claim, but of course, yours may vary a bit depending on your state laws. Your insurance agent or broker can be crucial in ensuring you comply with local laws. 

1. Give Your Employee the Medical Attention They Need

If needed, call 911 for emergency help. If the injury isn't life-threatening or doesn't require immediate medical care, give your employee the contact information for your company's designated medical provider. Ensure the employee knows how to contact the provider and schedule an appointment.

Prompt medical attention helps the employee heal and serves as documentation for the workers' comp claim. 

You'll also want to implement workplace safety measures to stop others from getting hurt. Following the Department of Labor regulations can keep workers from getting hurt or sick again.

2. Get the Details of the Incident

In general, here's what you need to do when an employee gets injured or sick on the job: 

1. Get the details of the work-related injury or illness: Think who, what, when, where, and how. Ask the employee to describe the incident in detail, including any equipment or tools involved, and consider any relevant contributing factors. You should also see if any surveillance footage is available and interview witnesses who saw the incident. 
2. Gather medical documentation: You'll need medical documentation from healthcare providers supporting the employee's claim. This may include medical records, doctor's notes, and any other relevant documentation that can help establish the extent of the injury, the required treatment, and their medical benefits. Depending on your state, the employee may need to sign a release form first. 

3. Notify Your Insurance Agent

After letting your agent or broker know about the injury, they'll likely have you do these two things to get the workers' compensation claims process started:

1. Fill out a First Report of Injury form: You'll need this if the worker needs medical treatment or misses a certain amount of workdays because of their injuries. (The number depends on your state). In this form, you'll explain the specifics of the accident and submit it to your workers' comp insurance carrier. 
2. Have employee fill out claim form: Your injured worker also needs to fill out an employee workers' compensation claim form. Ask your agent or broker for one, or search online for "[State] employee claim form." Your state may have one available. For example, these are the forms for New York and California. Once completed, send these forms back to your agent or broker. 

4. Wait for the Insurer to Approve the Claim

Once you've filed a workers' comp claim, the next step is to wait for the insurance company to approve it. 

How long do you have to wait for approval?

In some states, the insurer has a certain number of days to approve or deny a claim (such as 90 days in CA), while there may be no set timeline in others. 

Your workers' comp insurance provider may request additional information or documentation before deciding. If this happens, provide the requested information as soon as possible to avoid any further delays in the approval process.

What if the claim is denied? 

If you don't think the denial is justified, you can:

• Ask the insurer to reconsider.
• File an appeal with your state's workers' compensation board or commission. 
• Work with a workers' comp attorney.

You'll likely have to gather more documentation and evidence to support the claim for all options. 

5. Support Your Employee in Returning to Work

Returning to work after an injury can be challenging for your employee. As an employer, you can help make the transition smoother for them by providing support and accommodations. 

Here are some ways to do that:

• Stay in communication: Keep workers updated on any changes in the workplace, such as new equipment or procedures that may affect their job. ‍
• Accommodate their needs: Work with injured employees to identify any necessary job adjustments, such as modified work hours or duties, ergonomic equipment, or assistive technology, so that they can do their job safely and effectively.‍
• Provide training: If your employee has been away from work for an extended period, provide (if needed) any additional online or in-person training they need to refresh their skills and knowledge. This can also help boost their confidence and ease their transition back to work.

6. Monitor the Claim's Status

Once you've submitted the workers' comp claim, you want to check in regularly to see that the claim is being processed correctly and that your employee is receiving the necessary workers' compensation disability benefits and medical bill coverage. 

You can contact your insurance agent, broker or claims adjuster or check your customer portal with your insurer. 

Some things you'll want to keep track of are:

• Notices from the Division of Workers' Compensation: This includes the first payment of benefits
• Employee medical treatment records: Doctor visits, surgeries, therapies, and prescribed medications 
• The employee's work status: Current work restrictions and accommodations needed to help them return and stay at the job 
• Communications with your insurer: Examples include conversations, emails, and written correspondence regarding claim updates, requests for information, and any disputes or resolutions

How Long You Have to File Claims in Your State

While every state has a different deadline for how fast you need to submit a claim, many of them require you to do so in a week or less.

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So, once you know about the incident, it's best to submit the claim as soon as possible to your insurer, either directly or through your broker. 

Your employees must know they only have a certain number of days to report workplace injuries and accidents to you. If they don't let you know about the accident, their workers' compensation benefits could be denied.

What Qualifies for Workers' Compensation Coverage?

Workers' compensation insurance generally covers work-related injuries and illnesses, regardless of who's at fault. The following criteria must be met to be eligible for workers' comp benefits:

1. The worker was hurt or sick as a result of their job duties.
2. The injury or illness happened while they were employed at your company.
3. Your business has a workers' comp insurance policy in place.

What's NOT Covered by Workers' Comp

Some circumstances not covered by workers' comp include:

• Injuries that occur while the employee is under the influence of drugs or alcohol
• Injuries that result from the employee's own intentional actions, such as self-inflicted injuries or criminal acts
• Injuries or illnesses that happen outside of the workplace when they aren't related to the employee's job duties, such as driving to and from work
  

Respond Immediately When a Worker is Hurt

The best thing you can do when an employee is injured is to respond immediately—make sure your team member gets the medical care they need, and you contact your insurance agent ASAP so you can complete all the right steps. 

While it's always stressful when someone gets injured, following all the steps involved in the claims process will help protect you and your employees—and hopefully bring you some peace of mind.