What Constitutes a Workers’ Compensation Claim? – National Workman's Comp Solutions-Florida | 855-852-0128
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What Constitutes a Workers’ Compensation Claim?

workers compensation claim

In the US, 94% of employees, which represents roughly 140 million workers, are covered by workers compensation insurance. According to data collected in 2013, these employees received a total of $8.2 billion in workers compensation claims that covered loss of survivor benefits, lost wages and lump-sum payments.

The injured worker’s medical bills amounted to slightly over $1.7 billion.

The compensation helps injured employees all over the country get the available treatment and have a portion of their wages during this time.

When your employees suffer injuries on the job or have work-related illnesses, they will sue you for worker’s compensation. This claim means they will get several benefits including medical coverage. However, to access these benefits, there are several steps that both the employer and the employee must follow.

This process can be lengthy and may be a bit complex. It is because there are several parties involved. These parties include the doctor, employer, employee, insurance company and the state workers compensation board.

Some facts such as the employee and the nature of injuries need verification. There is also a deadline for filling that needs you want to be met.

When Is It Appropriate to File a Workers Compensation Claim?

As an employer, you need to know that your employees are eligible for benefits as long as all these factors are true:
– The employer has worker’s compensation insurance
– The employee’s injuries are as a result of the job
– The injured workers are employees of the company and not freelancers.

Many of the injuries that occur on the job are within the scope of the employment. If it does not happen within the scope of the working environment, then the workers may not be compensated. These injuries include diseases, accidents, traumatic injuries and illnesses that result from chemicals and work-related events.

The costs may begin right from the ambulance ride to the emergency room and the long term costs of lost wages and physical therapy. In some cases, there is a portion that will cover your legal fees.

In case of death, it will also cover funeral costs and death benefits. This allows the families to grieve without the added stress of money related expenses. It may also give dependents some money that they can use to get back on their feet.

These insurances are particularly mandatory if you work in a high-risk industry. It is also a great employee retention strategy because employees need to know that their health is catered for.

What Will This Insurance Not Cover?

-Self-inflicted injuries
– Stress and other psychiatric injuries
– Injuries that happen on the commute to and from the workplace
– Injuries resulting from horseplay and fighting
– Those that result from committing crimes, while in violation of company policies or while under the influence of alcohol or drugs

As soon as an employee realizes that their injuries are covered by this assurance, time is of the essence. The employee needs to report the injuries and collect related benefits as soon as possible.

If you suffer an injury while on the job, make sure that you report to your employer as soon as it happens. Remember that any delays in filing will result in the company refusing to provide the employee compensational benefits. This delay will also give your employer the impression that the claim is not legitimate and that you are afraid of suing.

The area gets grayer for cumulative work-related injuries. For instance, a technical writer may develop a carpal tunnel syndrome over a period of time.

The claim on this type of injury begins once:
– The writer takes time off work because of the injury
– They can prove that the injury is work-related

Covered Employees

Each state has different parameters that define when the employer can take the insurance. In most states, this minimum number rule means that employers cannot get workman’s insurance until they reach the minimum number of employees required.

While some states need employers to have insurance taken up as soon as they have employees even if it is just one.

In some states, employers are excluded from taking compensation insurance if they work in some industries. This means that domestic workers, agricultural employees, and seasonal employees will not be covered. Independent contractors and freelancers are excluded from these claims.

How to File Worker’s Compensation Claims

For you to initiate the claims processes here are a few things employees must comply with.
– You need to notify your employer of injuries as soon as they happen. Include the time, date, how the injury happened and type of injury.
– Have a formal workers compensation claim

From here, the insurance company will select a doctor who will do an independent medical examination to verify that the injuries are work-related. This doctor will also report to the company. The insurance company will use these results to create compensation offers.

Remember to check the workers’ compensation boards to find out what your state covers.

The Compensation Statute of Limitation

The duration of reporting injuries to the insurance company and employers varies from state to state. For instance, in the state of Maryland, workers have 30-45 days to report that injuries to employers.

If they do not, they may not have grounds to receive the workers’ compensation.

The notification should never be by word of mouth. You can write an email or a formal letter. Include therein, the injury you suffered, details of how it happened, where it occurred and when it occurred.

Filling for the Workers Compensation Claim Should Be a Straightforward Process

In case the workers compensation claim results in disputes, consult the compensation commissioner’s office within the state. You should also consult an experienced attorney to handle the issues on your behalf.

Contact us for a quote on a workers compensation plan unique to your business.

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Kyle

Kyle is one of the co-owners of National Workman's Comp Insurance Solutions. He is an expert specializing in Florida business workers comp insurance, for small to large businesses. Workers compensation insurance is complicated and he is here to help you with the risks and premiums to get you covered.

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