A Useful 5-Step Guide to Filing a Workers’ Comp Claim

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When you’re injured on the job, the financial and physical fallout can be devastating.

Thankfully, employers are required to have workers’ comp insurance that can help you stay financially afloat during this difficult time. Because of this, it’s crucial that companies instruct their staff to report any workplace injuries right once. You must first gather information and paperwork regarding the occurrence before filing a claim with your workers’ compensation insurer, which is normally your responsibility as the employer. When you find yourself in this tense situation, there are five steps you must follow to successfully file a workers’ comp insurance claim:

1. Report Your Workplace Injury

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While it may seem like a no-brainer, you need to report your workplace injury as soon as it happens. The longer you wait, the more ammunition you give to insurers who may try to deny your claim, as well as any bosses that may try to dispute your injury. You should ensure that your boss also understands the full extent of your injuries, and why the injury occurred in the first place. Doing so will help you, and support any evidence surrounding your injury that you might gain.

The claims procedure begins at this point. When a person has an injury at work, they should notify their employer right away. When documenting an accident, the victim should provide all pertinent information, such as the date it happened, the kind of damage they suffered, as well as the circumstances around how and where it happened.

The more vigilant you are about completing this first step, the quicker you can move on to the next four steps. If you feel under pressure to not file your claim, you should contact a workers’ comp attorney ASAP. However, workers’ compensation claims can differ significantly by industry, according to Rosenfeld Injury Lawyers, so you’ll need to take this factor into account.

2. File Your Incident Report

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After you’ve officially reported your injury to your boss and the insurer, it’s time to file your workers’ comp incident report. While you will be involved in this step, however, it’s actually your boss who will file your incident report (due to them being the holders of your workplace’s workers’ comp insurance). The incident report will contain the following: when the incident occurred, what injuries were suffered, the situation that led to the incident, the official diagnosis and medical report, and finally information involving witnesses who say the injury occur. Gathering all of this information as quickly as humanly possible will allow you to ensure your incident report is strongly constructed.

3. File Your Official Insurance Claim

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Now it’s time to officially file your workers’ comp insurance claim (although your boss will once again be handling this step in an official capacity). The company’s HR department, or the equivalent of an HR department, will be in charge of handling this step through to completion on behalf of the injured employee. After it’s been submitted, it will be in the hands of claims adjusters working for the workers’ comp insurance company. The timeframe for how long workers have to officially file a workers’ comp insurance claim, and how long insurers have to respond to them, differs from state to state. This becomes another area where a qualified workers’ comp attorney can help guide you through the process more effectively.

4. Participate With Any Needed Investigations

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In almost all cases, some type of investigation will take place to confirm or deny your workers’ comp claim. Both your employers and the claims adjusters are likely to become involved during this step. While you should be cooperative during the investigation at all times, you will also want to ensure you’re not being unfairly treated or taken advantage of.

For this reason, having a workers’ comp attorney by your side is a necessity if you suspect that any foul play is involved. Employers will look for any signs of falsified workers’ comp claims during this point as well – such as faked injuries, exaggerated injuries, misrepresented injuries, and more. You must be fully honest during the investigation and the filing process. If you fail to do so, even by accident, it could negatively impact your ability to successfully win your workers’ comp claim case.

The carrier will be on the lookout for anything that would indicate a false claim during in the inquiry. For instance, it may be a sign that an accident occurred over the weekend or during an off-hour when an employee reports it the first thing on a Monday morning.

Employers should be aware of the fundamental guidelines, such as those relating to inquiry, timeliness, and grounds for refusing a claim. Although adjustors are knowledgeable in the law, their caseloads usually prevent them from addressing associated employment law concerns. The very best practice is to work with your adjustor to look into, decide on, and coordinate ancillary medical leave and employment legal concerns.

5. Track Your Claim’s Progress

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As you heal from your injuries, you can track your claim’s progress to ensure it’s moving along as expected. Allowing yourself the time and space to heal during this waiting time is crucial. Additionally, it’s not abnormal for claims adjusters to ask for additional information about your case throughout the progress of your case. Staying cool, calm, and collected is of utmost importance during this stage. With any luck, your claim will go smoothly, and you’ll receive the workers’ comp claim payout that you deserve in a timely fashion.

Help is Out There

Never let an employer tell you that workers’ comp is not an option for you. The claims adjuster will collaborate with the wounded worker throughout the whole workers’ compensation claims procedure to organize appropriate medical care and guarantee the speedy.

If they say this, it’s a massive red flag that you should let your legal representative know about immediately. Thankfully, the vast majority of workers’ comp claims are processed without malicious interference on the behalf of employers or insurance adjusters.