Home blog Understanding the Timeline for Workers' Compensation Insurance Claims

Understanding the Timeline for Workers’ Compensation Insurance Claims

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As a business owner, you should already know the basics of worker’s compensation insurance and related federal and state laws. But from a logistical standpoint, what’s the first step to take when an employee suffers an injury or reports a condition related to their work condition?

You’re relying on insurance companies, strict laws, critical health conditions, and healthcare providers, that’s why there’s a timeline you need to follow as soon as an employee gets injured.

The Injury and Immediate Aftermath

The worst of the injury is directly related to the first few minutes of its occurrence. As soon as you’re notified of an accident on company grounds, start by ensuring the threat is neutralized, and no more damage can occur.

Next, clear the area and move all employees to a safe location while assisting the injured ones—calling an ambulance or the fire department might be necessary. Because your insurance policy providers need to investigate the legitimacy of the accident and pinpoint the responsible parties, it’s important to leave the area of the incident untouched. You should also gather photo and video evidence that could be useful in the investigation later if it’s safe to do so.

OSHA Reporting

Depending on the severity of the situation and the extent of the employee’s injury, employers might be legally required to report to the Occupational Safety and Health Administration (OSHA) within a set timeframe. Failing to do so within 8 hours for a fatality, and 24 hours for other serious injuries, could result in legal consequences. Alternatively, you could face legal consequences if you refused to provide adequate resources to the employee.

The Workers’ Compensation Insurance Claim

Once the injured employee receives the medical attention they need and is deemed to be in a stable condition, they need to fill out a workers’ compensation claim and submit it to the insurance policy provider in a timely manner. 

As their employer, you must streamline this process for them by providing them with the needed paperwork and any necessary information along with a reliable and fast method of contact with the insurance provider.

Claim Review and Compensation Offer

After receiving a workers’ compensation insurance claim, your insurance company will investigate and look into the claim and incident to ensure it falls within your coverage. Workers’ compensation insurance covers injuries in the workplace and during work hours, whether overtime or not. This includes anything from carpal tunnel and back injuries from repetitive movement to slipping injuries and any health repercussions resulting from exposure to toxic chemicals or a poor work environment.

However, your insurance provider may choose to deny the employee’s claim if they suspect it falls outside of their coverage. For example, if the employee was under the influence of drugs or alcohol, if the injury was self-inflicted, if they were violating the law, or if the injury occurred outside work hours and location. 

If they approve the claim, the insurance provider will offer to cover the injured employee’s medical bills, the costs of required retraining and rehabilitation, along with short or long-term salary replacement.

Employee Accepts or Initiates Negotiations

The employee who filed the claim—or their immediate family if their medical condition doesn’t allow it—has the right to either accept the insurance company’s offer or refuse it. If they accept, the insurance company will pay their deserved bills. Alternatively, if they believe the compensation for their injury is insufficient or unfair, they can start negotiations with the insurance company.

If the employee (or their attorney) and the insurance company are unable to reach an agreement, they can escalate the situation to a court lawsuit. There, a judge would be the one to determine the appropriate settlement.

Workers’ Compensation and Statutes of Limitations

Statutes of limitation are the time limit an employee has to file a workers’ compensation claim after the injury occurred or the first time they noticed related symptoms. They are included in workers’ compensation state laws and not company policy. If they fail to do so, they may lose the right to compensation.

It’s also critical that an employee doesn’t miss this deadline because you didn’t provide them with the necessary paperwork and insurance company details.

Informing Your Workers

Workers’ compensation insurance isn’t strictly business-related. It’s important that your employees are aware of federal and state laws regarding their rights. Make sure everyone is prepared both mentally and legally if an accident were to occur. Additionally, the more you show you care for your employees’ health and well-being, the less likely they are to file lawsuits against you during or after their employment concludes.

Carmel Issac
I am absolutely in love with writing and by working with News Whizz, I have developed a passion for it. It helps me to stay updated and know what is happening around the globe.

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