After the insurance provider approves the claims, the benefits will automatically be given to the affected employee.
Employees are the lifeblood of an organization. Their important role doesn’t go unnoticed as the government grants them multiple rights and privileges for their protection. One of those is the worker’s compensation law, which seeks to compensate employees for all the expenses concerning injuries sustained while in the workplace.
This coverage is mandated. However, the benefits can differ from one state to another. From the employers’ perspective, worker’s compensation is a form of social insurance. In exchange for providing this coverage to employees, the injured employee is then barred from filing civil suits against their employer.
If you or anyone you know has been injured on the job, you’re entitled to file a worker’s compensation claim with the help of experts such as Kingston lawyers. To do such, you must first take steps so your claim will be successful.
This article gives you a step-by-step guide on the worker’s claim process.
- Receive Prompt Medical Care
The first and most important step in the whole worker’s compensation claim process is to receive medical care, especially for big accidents that result in serious injuries. The employee shouldn’t run away from medical care due to fear of medical expenses as they have that assurance anyway. Remember that as long as the situation doesn’t fall under any of the disqualifying circumstances, then any expenses spent on medical care will be reimbursed, regardless of who is at fault for the injury.
Furthermore, it’ll be challenging to prove the expenses due to the injuries sustained without the hospital and doctor’s bill and medical certificate. Receiving prompt medical care is absolute for the worker’s compensation claim to be successful and to prove financial and economic damages. It can also draw the line between a good recovery and a potentially more drastic consequence due to delays in receiving the necessary medical attention.
- Report the Incident to the Employer
No worker’s compensation claim can ever prosper without the employer being made aware of the accident that occurred. This doesn’t have to be the owner of the company per se. During the hiring and onboarding process, each employee should be made aware of the chain of command so they’ll know whom to report the onset of injuries to. Usually, this is the department head or leader of the affected employee or the human resources (HR) manager.
It’s also during this process of reporting the accident that the department head or HR manager should contact the family members concerned. This should be on the employee’s record and file which they’ve completed during hiring.
- Ask for a Worker’s Compensation Claim Form from Your Employer
After the employer is notified of the accident or injury, the employer should give the affected employee a worker’s compensation claim form. It’s a must to have this and fill it out even while you’re obtaining the medical assistance you also need.
Without completing the form, the employee may be barred from getting the worker’s compensation benefits they’re entitled to. Take note that those benefits are a must-have to have a better recovery and hopefully get back to work as soon as possible.
During this phase of the process, the injured employee may opt to hire a worker’s compensation lawyer if they determine that doing so is in their best interest. There may be some matters or intricacies in the form that are challenging to answer or other legal repercussions that the employee may have.
Most importantly, states have their respective prescriptive periods concerning filing worker’s compensation claims. The employee has to satisfy that period; otherwise, their claim may be forever barred. If the employee is physically unable to move around and has to stay in the hospital for a long time, then having an attorney act on their behalf is definitely a must.
- Submit the Claim Form to the Employer’s Insurance Provider
Once the worker’s compensation claim form is completed, the employee or their representative must return it to the employer so the latter can also forward the same to their insurance provider.
After the insurance provider approves the claims, the benefits will automatically be given to the affected employee. Those benefits can cover claims like medical expenses, compensation for mental trauma, reimbursement for lost wages during the period of unemployment, and in worst-case scenarios, funeral and death benefits if the employee dies subsequently as a direct result of the injuries sustained.
However, it’s also worth noting that workers’ compensation doesn’t cover certain injuries, even if sustained on work premises and during work hours. Some of those disqualifying circumstances include:
- Accidents that happen outside work. For example, commuting to and from work;
- Accidents that occur because employees were engaging in activities in the workplace that are, however, against company policies;
- Accidents or injuries that are self-inflicted.
- An Approval or Denial of the Claim Will Now Be Made by the Insurance Company
Based on the circumstances and facts alleged in the forms, the insurance company now evaluates whether or not the claim will be approved or denied. Here’s a brief run-through of what happens during this stage:
- If the claim is approved, the insurer informs the employer, and the employer then contacts the employee or their representative for the payment details.
- If the claim is denied, the employee either file a formal appeal to the state worker’s compensation board or commission or request consideration from the insurance company.
Accidents and injuries can happen anytime. No one is ever prepared for it. And, if you happen to work for a business that’s quite risky, the chances of obtaining injuries will definitely be higher.
However, you don’t need to worry as there’s protection and recourse in the law through the worker’s compensation law. Employees are eligible for such. But for a claim to be successful, there are steps that first have to be satisfied.
The run-through above should only be your guide. When all else fails, and you’re still unsure what to do, a compensation lawyer will always be your best help. That said, find and hire a good one so you’ll have all the assistance you need to process your claims.