Work Comp Claims

So You Have a Workers' Compensation Claim

(Now what?)

Workers Compensation Claims

Insurance's big selling point is how well you're covered when you have a claim. A claim is when you're most vulnerable, and it's also when your insurance company should come through for you. 

Having a great independent insurance agent on your side is crucial to making sure your workers' compensation claims run efficiently, smoothly, and most importantly, that you have the coverage you need. The worst feeling in the world is hearing those tragic words "you don't have coverage for that." It's best to get it right the first go-around.

What Is Workers' Compensation Insurance?

First things first, you need to know what workers' compensation insurance is. It's a policy obtained by an employer or independent contractor that provides coverage for medical expenses arising from a work-related injury, mental disability, or illness. It will also cover employee or owner wages up to two-thirds of the regular compensation while they are out and recovering. 

Besides the fact that most states make having workers' compensation insurance mandatory in some form or fashion, it's just plain smart. Think about it, you likely won't want to pay thousands of dollars in medical bills if you or an employee gets injured on the job, will you?

Not to mention the money you would shell out on wages when they are unable to perform regular work duties. Workers' compensation insurance makes sense in more than a few ways, which leads to the most important piece of a policy, how the claims are handled.

What's the Process for a Workers' Compensation Claim?

The process is fairly simple assuming you got yourself the best independent insurance agent this side of the world. Walking through a good claims process will shed some light on how it's supposed to work. 

A "good" workers' compensation claims process:

Step 1:
Employee A accidentally tripped over their own feet, falling down a lofty flight of stairs.
Step 2:
Employee A needs medical attention and goes to the doctor only to determine they have a broken leg and a twisted wrist.
Step 3:
You, as the employer, immediately file a workers' compensation claim within the first 24 hours using your independent insurance agent.
Step 4:
You and Employee A are called by an assigned adjuster to get the claim information firsthand within the first 24 to 48 hours. After the adjuster has spoken with all applicable parties, they submit their findings to the insurance company.
Step 5:
Your trusty independent insurance agent is communicating with you, your employee, and the insurance carrier every step of the way to make sure all parties are making strides in proper coverage for the claim.
Step 6:
The insurance company makes their assessment of information, and the deciding factor on whether or not the claim is covered. Since this claim happened on work property while at work, it appears it would be covered under the workers' compensation policy. 
Step 7:
Employee A recovers after a few weeks and was even able to come back to work handling some light-duty tasks until full restoration. 
Step 8:
Your independent insurance agent sends you a card and honey baked ham for good measure. This part is optional and dependent on your agent, but hey it could happen.

Now you know how good it can be. What about when it's bad? 

A "bad" workers' compensation claims process: 

Step 1:
Employee B came barreling into the office with a heavy load of toners and threw out their back.
Step 2:
Employee B goes to the doctor to find out that a disc has slipped and they will need back surgery to cover the damage.
Step 3:
You immediately call your 1-800 number info commercial purchased insurance carrier to file a claim within 24 hours of the incident.
Step 4:
After waiting on hold for two hours you are connected to a stranger halfway around the world who takes down your information and promises that an adjuster will call you back in a timely manner.
Step 5:
After three days go by, you call that trusted claims hotline again, wait on hold ... again, and finally get connected to a live person only to find that your claim got lost in translation and you need to file it again.
Step 6:
Employee B is complaining that their medical expenses after surgery are coming due and you better pay up or else. 
Step 7:
You finally get a call from the adjuster and they are less than helpful. Your claim has been pushed and pulled around for so many days you start to think it will never be resolved. 
Step 8:
After fronting a good chunk of the money to cover your employee's medical expenses and wages, the insurance company gets back about the claim and apparently you didn't have that good of coverage to begin with. You were assigned a hefty starting deductible which results in you coming out of pocket for the first $10,000 before they pick up the rest. 
Step 9:
You take their botched reimbursement and make a call to a highly recommended independent insurance agent in your area to get better coverage moving forward.
Step 10:
You lived, you learned, and now you can look forward to a good claims process in your future. 

When to File a Workers' Compensation Claim

Immediately. Do not let a 24-hour period pass without filing a claim when an owner, member, executive, or employee gets injured while at work. If you wait to file, then the claim may be denied or have complications due to waiting. 

Most employers ask which injury they should file, like if an employee gets a paper cut and needs a Band-Aid. Should that be filed? What about when an employee is running an errand for the company on work time and gets into a car accident? All of those, big, small, and indifferent injuries should be filed. 

The insurance company looks at the workers' compensation claims filing, not so much on the frequency of the claims, but more on the length that the claims remain open and paid out. So claim away, and in fact, they want you to file every incident to make sure you don't become liable later. 

Benefits of an Independent Insurance Agent

If you don't know by now, an independent insurance agent can save you a lot of hassle when it comes to workers' compensation claims. Avoiding a bad claims experience is possible with the right resources and your independent insurance agent, who is a great resource. 

They work with multiple insurance companies finding you the best pricing and sufficient coverage for your business. So whether you're just starting out or looking to make a move, an independent insurance agent is right around the corner.  

Share this page on Twitter Share this page on Facebook Share this page on LinkedIn