May 20, 2024

What’s A Typical Workers Comp Claim Process?

3 min read
workers comp claim

Accidents can happen at work, leaving the victim and the company they work for in a huge financial mess. Due to such unpredictable occurrences at work, insurance companies have policies such as workers’ comp that help cater for medical costs and lost wages. 

Workers’ compensation is an insurance policy that protects business owners and employees when an accident happens. With such a policy in place, the company is safe from legal action and avoids covering such expenses out of pocket.

Below is the typical process for workers compensation claims.

An Injury Happens

Employees file workers’ compensation claims when an accident happens at work. The injury must result from doing your job to get compensated. However, there are some injuries that the insurance company will not cover, such as injuries that happen on your way to work.

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The best way to know which injuries can be compensated for is to talk to your HR and understand your company’s workers’ compensation policy. You should seek medical attention immediately after the accident and consider filing a claim after you are out of danger.

You File Workers’ Compensation Claims 

Once you have been treated for your injuries and feel better, you can file a workers’ compensation claim through your employer. The employer will give you the claim forms to fill out and then forward them to the insurance company.

You will need to present medical records to show you were treated for the injury and other documents like invoices. Once you have filled out the forms, the next step is for the employer to present them to the insurance company for evaluation.

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The Insurance Company Reviews Your Claim

The insurance company evaluates your claim based on various factors, including the validity of your claim. They can accept or reject your claim. Knowing which injuries your company policy covers is important to know whether you have a valid claim when it happens. 

Some of the injuries that most policies will not cover include psychiatric conditions, accidents that happen on the way to work, and those that are self-inflicted. Also, if you engage in activities that are against the company policy and get into an accident, that will not be covered by the workers’ comp. 

You Get Compensation

Once the insurance company has evaluated your claim and deliberated on it, they will accept or reject it. If your claim is rejected, you can seek legal advice and pursue the matter further through a lawyer. If they accept the claim, you will get compensation through a lumpsum payoff or a structured payment system.

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Workers’ compensation claims are a lifesaver for the company and the employee. Companies and insurance policies have different credibility criteria, but most cover the usual work-related injuries.

People working in construction and other industries with a high risk of injuries should have a workers’ compensation policy. Please note that you should file your workers’ compensation claims within one year since the injury happened, or you will not be eligible for compensation. You should also have all your medical documents to show the extent of the injury.

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