When and How to File a Workers' Compensation Claim

Workers' compensation insurance is an important part of business insurance. Protecting your business and employees from the cost of unexpected accidents and illnesses is essential to your financial success. Just one work-related incident could cost your business tens of thousands of dollars or more if you lack the right coverage. It's also critical that you and your employees understand when and how to correctly file workers' comp claims if an occupational accident happens.

Fortunately, a local independent insurance agent can help you find all the workers' comp you need. They can also help you file workers' compensation claims if the time comes. But first, here's a guide to filing workers' compensation claims the right way.

What Is Workers' Compensation Insurance?

Workers' compensation insurance is taken out by an employer or independent contractor. It pays for medical expenses resulting from a work-related injury or illness.

The policy also provides coverage for a portion of a worker's lost wages while they need time off work to recover. Workers' comp typically replaces up to two-thirds of an employee's typical pay.

Do I Need Workers' Compensation Insurance?

Whether your business is required by law to carry workers' comp depends on a few factors, one of which is your location. Each state has a different set of rules and requirements for workers' compensation insurance, but most states mandate this coverage either through a private insurer or a state-funded program.

Either way, if you're an employer and have employees, you should have a workers' compensation policy in place. This essential coverage can help your business avoid hefty lawsuits and potential bankruptcy.

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How to Apply for Workers' Compensation from a State-Funded Program

As a business owner, knowing where to get workers' compensation insurance can be a bit confusing if you're not familiar with your state's requirements. Four states have mandatory state-funded workers' compensation insurance programs, including North Dakota, Ohio, Washington and Wyoming.

If you reside and do business in one of these states, you're required to get workers' compensation through the state program rather than going through a private insurer. Your independent insurance agent can be a great resource when it comes to state programs and understanding your state's workers' compensation laws.

The application process for workers' compensation from a state-funded program goes like this:

Following these five simple steps can help ensure that you're on the road to a better-protected future as a business owner.

When to File Workers' Compensation Claims

Employers should ensure their employees understand when to file workers' compensation claims to ensure the process gets completed in an appropriate time frame. Encourage employees to file a claim within 24 hours of an incident, whether it's a workplace injury, illness, or disability diagnosis.

If an employee waits too long before filing a claim, the insurance company may deny it, or the process may become more complicated than necessary. Employees should file workers' comp claims right away for any of the following:

• An on-the-job injury
• An occupational disease or illness
• A disability that develops due to repetitive job tasks
• A fatality due to the work environment or activities

Workers' compensation can cover the cost of medical treatment and rehabilitation for workers who suffer from a workplace injury, illness, etc. It can also provide death benefits to a beneficiary if a worker dies because of their job and disability benefits for employees who develop the ailment due to repetitive job tasks.

How to File a Workers' Compensation Claim

When an injured or ill employee needs compensation for medical care due to a workplace incident, it's critical they follow the claims process accurately and efficiently. Teach your employees to memorize and adhere to the proper process for filing workers' comp claims:

Step 1: Report the Incident

If there's been a workplace injury or illness or an employee receives a diagnosis for an injury, disease, illness, or disability that was caused by their job or work environment in some way, they must report it to their employer immediately.

Step 2: Complete a Claim Form

Next, the employer completes the right workers' comp claim form to submit to the Workers' Compensation (WC) Board in their state.

Step 3: Contact an Independent Insurance Agent

The employer contacts their independent insurance agent who can handle the entire claims process for them, starting by submitting the claim form to the WC Board. Their agent will ask them any necessary questions to ensure all details are reported accurately for the best chance at reimbursement.

Step 4: Talk to an Insurance Adjuster

Within 24 to 48 hours, an insurance adjuster should contact the employer and the claimant to gather the details of the incident or diagnosis. The adjuster will present their findings to the employer's workers' comp insurance company.

Step 5: Update from the Independent Insurance Agent

The employer's independent insurance agent will touch base to update them about the claims process and provide ETAs for every step.

Step 6: Receive a Decision from the Insurance Company

The workers' comp insurance company will notify the employer and the affected employee of their decision about the claim. If approved, a claim check with the agreed amount of reimbursement will be sent to pay for the employee's medical expenses, lost wages, etc.

Step 7: The Employee Gets Treatment and Recovers

If necessary, the employee will seek further treatment or take time off work to recover from their injury or illness. If the claim is approved, they may be eligible to receive a portion of their lost wages during their time off.

The workers' compensation claims process can be easy when you know what to do. If at any point you're unsure of how to file a workers' comp claim or what you can expect once you have filed, reach out to your independent insurance agent.

Is a Workers' Compensation Policy Expensive?

The cost of workers' compensation insurance varies depending on several factors, including your business's location and industry. Other factors that can impact your premium rates include:

• Number of employees
• Business operations and exposures
• Classification of employees
• Prior claims history

An independent insurance agent can help you find affordable workers' compensation insurance near you.

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The Benefits of an Independent Insurance Agent

When it's time to find the right workers' comp insurance to protect your employees, no one's better equipped to help than an independent insurance agent. These agents have access to multiple workers' comp insurance companies, so they're free to shop and compare policies and rates for you.

They'll get you matched to a policy that offers the best blend of coverage and cost. And down the road, your agent will still be there to help update your coverage as your business's needs evolve and can even file workers' comp claims for you.