As soon as you are aware of a possible work-related injury or illness, you should take action to provide medical treatment and report a claim. When you file a claim with your workers’ comp insurance company, you are notifying the insurer of an injury or illness that may be covered by your policy. By law, you must file a claim for every occupational injury or illness, with one exception: When the incident does not cause the employee to miss work for a full day or shift beyond the date of injury or illness, and also does not require treatment beyond the legal definition of first aid. Claims handling is one of the most complex areas of workers’ comp. You can prepare your business for future claims by reviewing some useful guidelines:
Reporting the claim
You should report the injury without delay. Timely reporting helps control claims costs while ensuring your employee gets prompt treatment. The legal deadline for providing your employee with the official DWC-1 claim form is within one working day of receiving notice or knowledge of the injury*.
*CHECK WITH YOUR STATE LAW
Validating the claim
Reporting a claim is not an admission of liability. Your insurance provider reserves the right to accept or deny the claim, even if the injured employee is already receiving authorized medical treatment. A key factor in approving the claim is whether the injury or illness arose out of and in the course of employment.
Treating the claim
On approved claims, injured employees are entitled to receive all medical care that is reasonable, necessary, and supported by evidence based treatment guidelines.
Managing the claim
Your insurer’s claims adjuster determines appropriate coverage and keeps in contact with you, your injured employee, and the medical provider. Claims have varying life spans. A non-disabilityor medical-only claim is less complex, involving three or fewer days of lost time from work. A more serious injury may result in a disability claim, with the employee eligible to receive compensation for physical impairment and lost earnings (see related article on disability claims).
Helping Injured Employees Return to Work
When one of your employees misses work because of a workers’ compensation injury, you may want to consider a “return to work” option. Under return to work, you bring injured employees back to work in either a transitional job, or in their regular job with some type of accommodation, as soon asmedically feasible.
The outcome is win-win: Numerous studies have shown that employees who can return to work more quickly experience faster, more successful recoveries. And for your business, minimizing time losses can reduce claim costs and help you maintain productivity.
If you need help returning injured employees to your workplace, we’ve got you covered. Each insurance company we work with provides you with dedicated resources and support to put a plan in motion.