To receive the benefits of workers’ compensation insurance, an employee injured at work must follow the correct workplace injury claims processes prescribed by their state. This usually involves reporting the injury to the employer and filing a formal claim with the insurer before the state deadline. Employers are expected to report work-related injuries according to the timelines set by their respective state workers’ compensation board.
The reporting process differs according to the state. However, when an employee is injured on the job, the employee should notify the employer within a specific time period. Then, the employer must notify the insurance provider (and the state workers’ compensation board, if required). Though it’s the employer who should report the injury to the insurance provider, the employee should also be available to ensure the accuracy of the personal and accident-related information being conveyed.
Of course, if the injury is critical, the required medical care should be ensured for the worker before the employer reports the injury to the insurance provider.
How does the workers’ compensation claim process work?
If a worker is injured on the job, the employer has a limited amount of time to submit the paperwork for the employee to receive workers’ compensation benefits. So, both the worker and the employer should act quickly when a workplace injury occurs. If you miss your state’s workers’ compensation claim deadline, your claim could be denied.
The process is typically as follows:
When an injury occurs, the employee must:
- Notify their employer of the injury (i.e. date, time, type of injury, how it occurred)
- File a formal workers’ compensation claim
The employer must:
- Give the employee the appropriate paperwork and guidance as required in their state
- File the claim with the insurance provider, in compliance with state law for reporting workplace injuries
The workers’ comp claims process varies based on the workplace location, since workers’ compensation insurance is regulated by the state.
How long does an employee have to report an injury?
Ideally, employees should report workplace injuries to their employers as soon as possible after the incident takes place. Workers’ compensation claim deadlines vary from state to state, but most states advise employees to report their injuries “as soon as possible”—a best practice no matter what the state.
For information about the notice deadline of your state, check out the rules of your state’s workers’ compensation board. For example, the employee must report an injury within 90 days of its occurrence in Iowa, while the deadline is 30 days in both California and Florida. In Colorado, the time given is even shorter at only 10 days. This time period is usually calculated based on one or more of the following factors:
- The date of the injury
- Your knowledge of the injury, or
- A doctor’s determination that your injury was sustained on the job
The second and third points apply particularly to injuries like overexertion or illnesses that develop gradually (e.g. arthritis or carpal tunnel syndrome), as no one would be able to determine exactly when you first started to develop the illness.
Depending on the state, if an injured worker is late in reporting their injury, they may lose their right to the benefits or get a reduced amount. In Colorado, for example, you lose one day’s worth of benefits for every day you’re late.
In addition to reporting an injury when it happens, employees who choose to file for workers’ compensation benefits should also submit a workers’ compensation claim form. The injured worker should turn in the completed form, along with documentation of medical treatment. The employer will then submit it to the insurance provider. The timeline for filing a workers’ compensation claim for benefits varies significantly depending on the state and can range from 1-3 years or more. It’s always best to report an incident as soon as possible, as this often reduces the time it takes to close a claim.
If an employer refuses to report an injury to their insurer, the injured worker may contact the insurance company and do so directly. If the employee is unsure of their workers’ comp insurance provider, they can contact the state’s workers’ comp board for assistance.
How long does an employer have to report an injury?
Once you, as an employer, have been notified about an injury, your responsibilities include providing guidance to the employee and reporting the incident to the insurance provider. Additionally, you should also provide the following:
- The proper reporting forms the employee needs to file to claim the insurance (these forms differ according to the state where the employer and employee are based, the insurer, and the type of injury sustained)
- Information on the employee’s rights and workers’ comp benefits, and
- Information about returning to work
If possible, the employer should provide the information and forms to the injured worker before they seek treatment. Some businesses now include such information in the initial employment packet for new hires. Note that failure to provide this information could lead to expensive lawsuits.
The official claims process can begin immediately after the employer is informed. Best practice states that you should provide the injured employee with a workers’ comp injury form and written workers’ compensation rights within 24 hours of being notified of the injury. The claims form or “First Report of Illness or Injury”, depending on the state, typically includes important details of the event such as:
- The nature of the injury
- When and where the injury occurred
- Additional details about the incident
- Medical treatment required to treat the injury
Once this form is filled, it must be submitted to the insurer as soon as possible according to the timeline provided by the state and the insurer. Along with the claims form, the employer may have to file other associated paperwork with their workers’ compensation insurance provider. In addition to all this paperwork, the injured employee’s doctor also needs to send the medical documentation to the insurance provider.
Depending on the regulations in your state, you might also need to submit documentation to the state workers’ compensation board. This may apply to all workplace injuries, whether the employee is claiming workers’ compensation benefits or not.
The insurance provider only evaluates the claim once all these documents have been submitted. It will later notify both the employee and the employer whether the claim has been approved or rejected. Depending on how quickly the claim is filed, this process can take up to a year or more. If an injury is reported and the claim is filed promptly, there is a higher chance of it being processed and closed quickly.
It’s important to remember that every situation is different. State workers’ compensation laws vary considerably, so make sure you do your research and speak with a trusted advisor when an employee injury occurs at the workplace.
Thanks for reading! Please note that this content is intended for educational purposes only. As laws change regularly, it is advisable to refer to your state legislation and/or an advisor for specific legal counsel. If you’re a small business owner, learn more about workers’ compensation insurance or check your current rate in 3 minutes.