In a perfect world, workplace accidents wouldn’t happen, and employees would never become injured or ill as a result of their job. Unfortunately, the reality is that over 2 million workplace injuries were reported in 2020 and the numbers seem to be increasing. As a business owner, you can institute safety policies and procedures to help keep your employees safe, but accidents do happen. What do you do when an employee becomes injured or ill as a result of their job?
This is where workers’ compensation insurance comes in.
The process of filing a worker’s compensation claim includes specific steps that both the employee and the employer need to take. This checklist can be helpful to ensure that the claim is filed correctly, and everything goes smoothly.
Step 1. Report and Asses the Injury/Illness
Employees should report any injuries or illnesses to their supervisor immediately. The following steps should be taken:
- Evaluate the employee’s symptoms and injuries
- Determine the best treatment option based on the medical situation
- Coordinate with in-network medical providers
If your business has on site nurses, you should have the nurse evaluate the employee. Depending on your insurance carrier and your workers’ compensation insurance policy, you may have access to on-call nurses or triage lines that can assist in the evaluation of any injuries or illnesses and need of medical treatment.
Step 2: File A Claim
Once the employee has been evaluated and gotten any immediate medical treatment required, the next step is to have your employee file a workers’ compensation claim*. From there, it’s your responsibility as the employer to forward the claim to your workers’ compensation insurance carrier.
*Depending on your state, there is a time limit in which a claim needs to be filed.
Step 3: Document Everything
Documentation is important when it comes to a workers’ compensation claim. The following steps should be taken to ensure proper documentation of an injury or illness:
- Take photos of the injury and the area where the injury occurred as soon as safely possible. Make sure to photograph anything that may have led to the injury such as a wet floor, exposed electrical cords or obstacles, etc.
- Have the employee complete an incident report as soon as safely possible. This report should include details such as the date and time of injury, nature of injury, what happened to cause the injury, and the names of any individuals who witnessed the injury.
- Have the employee’s supervisor complete an incident report.
- Interview any witnesses and have them provide statements about what they observed at the time the injury occurred.
- Collect copies of any additional reports or documentation such as medical reports.
Step 4: Finalize The Claim
Workers’ compensation claims can take weeks or months to reach resolution, depending on the severity of the injury or illness. As the employer, make sure to work with your workers’ compensation insurance carrier to complete any needed information and take any steps needed to finalize the claim.
In the event that a claim is denied, the employee should be aware of their right to request reconsideration or file an appeal. The appeal may go to the state workers’ compensation commission or board, which could lengthen the claims process.
Step 5: Return To Work
Once a claim is finalized and the employee has provided written notice that they are medically cleared to safely return to work, the return-to-work process will begin.
Your workers’ compensation insurance policy may include the following:
- Guidelines for what duties an employee will or will not complete upon their return
- What steps the employee should take if their injury prevents them from carrying out their normal duties
- A communication policy for notifying the employer regarding any doctor appointments and return to work statuses
Navigating the workers’ compensation claim process can be overwhelming but having a clear timeline and written process of what should be done and when can help make it easier for all involved. A clear plan should ensure that employees understand what their rights are, what types of injuries or illnesses need to be reported, when and how to report injuries and illnesses, how to file and document their claim, and what their return-to-work options are following the finalization of the claim.
With Gannon Associates Insurance, we have staff on hand to help our clients navigate the workers’ compensation insurance process. For more information regarding your workers’ compensation insurance options or the services we offer to our clients, give us a call at 844-GANNONS.