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When To Claim Workers’ Compensation Insurance?

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If an employee gets injured during the workplace or passes through some incident that affects its health then workers’ compensation will benefit him by compensating the workers for his wages and providing expenses for medical care.

The employees that can claim include all those that are working under the employer’s business. But according to some regulations, the following employees are excluding:

  • Casual workers
  • Independent contractors
  • Railroad employees
  • Business owners
  • Maritime employees
  • Volunteers
  • Farmers and farmhands
  • Employees of private homes

How does Workers’ Compensation claim Works?

Employees who experience a work-related injury or some occupational illness should report the incident to the company. He must claim for the benefits within the reporting period, and reporting time varies according to the state.

The following is a detailed procedure of how to claim workers’ comp insurance:

1. Reporting to the employer

The first step of claiming is that the employee must report the injury to the employee. Make sure that the injury is only work-related that may be slipping on a wet patch, illness due to chemical,s, and others. In case there is an emergency, the worker can rush to the nearest doctor and can claim through a file received from the doctor.

A written notice of the injury should be provided to the company within the reporting deadlines.

2. Providing Employee With The Necessary Paperwork

As the employee notify the employer about his injury, he is compelled to provide paperwork to the employee, that includes:

  • Reporting forms from the workers’ comp insurance.
  • The form is used for reporting to the state workers’ compensation board.
  • Complete information on the workers’ rights.
  • Information about the benefits he will be receiving and returning to the work.

If the employer fails to provide all this paperwork then he may pass from the lawsuits.

3. Approval Of Claim By Employer

The employer will file the claim of the employee by depositing the paperwork to the workers’ comp insurance carrier. Along with this, the workers’ doctor also has to mail the medical report of the ill employee to the insurance company. Employer will submit all the documentation regarding employees to the board of workers comp insurance.

4. Insurance Company Response

In case, the insurer doesn’t get all the required documents or don’t think that the worker deserves benefits, then workers’ comp will disqualify the employee from the insurance.

If the claim is approved by the insurer then he will contact the employee and ask them for payment details. In both cases the employee can:

  • Accept the payment offer, which may include costs for medical bills, a portion of lost wages, and medicine.
  • Adjust for the lump-sum settlement.
  • Ask to review his case or appeal for the insurance(if the insurer denies the claim).

5. Returning to Work

The last step in this is that the employee must notify the insurer and employer about his joining back to work. This must be done via written notice where the worker shows his willingness about returning to work as he gets recovered sufficiently.

If the case prolongs, in case of severe injury then workers’ compensation will keep on providing the benefits. To avoid injuries in the future, the employer should provide proper training and ensure to provide workers with a safe working environment.

How Insurance Pays a Workers’ Comp Claim

After approval of the workers’ compensation claim, the insurance company will pay for the injured or sick employee who has any work-related injury. Neither employer or employee themselves pay for any benefit. All in all, all the payment will be done by workers’ compensation.

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