Whenever an employee is injured or ill at work, they have a limited amount of time to file a claim for the injury. A worker’s compensation insurance claim may be denied if this procedure is not followed. Thus, employers should train their employees to report work-related injuries immediately. The employer is usually responsible for submitting a claim to the workers’ compensation insurance provider, but they’ll need to first gather documents and details about the incident.
If an employee has been injured, the first thing you should do is redirect them to seek medical treatment, if they have not already done so. Here’s how you can start the claims process:
1. An Employee Reports a Workplace Injury to their Employer
Your employees should understand that if they become ill or injured on the job, they must notify you as soon as possible. The employee is typically required to give written notice to the employer. In addition, the employee should file the claim as soon as possible since waiting too long will make the employer or its insurance company skeptical. The sooner the employee files the claim, the faster he/she will receive the benefits.
In The State of Florida, the employer must be notified within 30 days to report an injury. Whenever necessary, your employee should seek immediate medical attention. Emergency treatment can be obtained at an emergency room or urgent care center. All other medical treatments will depend on the rules of your state.
2. Employers Provide Injured Workers with Documents and Next Steps
Once you become aware of an employee’s injury, you will need to inform them of their rights, workers’ compensation benefits, and return to work instructions. Workers’ compensation claims in Florida are filed by employees completing a form and submitting it to their employer. The form details the kind of injury and where, when, and how it occurred.
Workers’ compensation information should be provided in your new hire employment packet so your employees are aware of their rights if they’re injured on the job. If you fail to do so, you could be sued.
3. Employers File a Claim When an Employee is Injured
As soon as the employee notify the employer, it must send the claim form and all supporting documentation to its workers’ compensation insurance company within seven days. Once the employee reports an injury to the employer, he/she will submit the forms to the insurance company and the state workers’ compensation agency. The employer must send the worker to an occupational doctor.
After that, the insurance company will determine your eligibility for benefits by reviewing your medical records, analyzing your work experience, education, and wages, and ordering a medical examination.
4. The Claim is Approved or Denied by the Insurer
Once the insurance company approves a claim, it will inform the employer and contact the employee to arrange payment.
It is best to accept the insurance company’s payment offer, which may cover your medical expenses, medicine, disability payments, and a portion of your lost wages. Also, it is recommended to consider negotiating for a lump-sum payment or a large structured settlement.
An employee whose workers’ compensation insurer denies benefits has the option to ask the insurer to reconsider or may appeal to the state workers’ compensation board or commission.
5. Employee Returns to Work
When an employee recovers from an injury and is capable of returning to work, they must notify both their employer and their insurance company. A permanent disability benefit may be paid by the insurance company, depending on the severity of the injury.
Employers often create formal programs to get workers back to work as quickly as possible.
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