What is the Process for Workers’ Comp Claim

Admin February 28, 2019 Workers Compensation

An injured employee needs to follow the due process to be compensated. However, the employers should also cooperate with the injured employee so that the compensation process is fast-tracked. This will ensure that no further health damage is caused to the already suffering employee.

The injured worker needs to submit paperwork; usually between 30-45 days after an accident as required byCalifornia Workers Compensation guidelines. Both the employer and the employee need to act fast within the required time-frame. Otherwise, the claim is denied on the grounds of merit.

Here are the basics steps that need to be followed for aworkmans comp insurance.

1. The Employee reports the accident to the Employer

For a successful claim, the accident must be work-related. The law stipulates that the employer should be made aware of any injury incurred by the employee in the line of duty. This can also be an illness that was contracted in the due process of working. In emergencies, the injured employee is rushed to the hospital where he/she will be given a medical report by the doctor to be used to make a claim. In less immediate situations, the injured workers go to the hospital got get a diagnosis and a medical report to file with the workers’ comp claim form.

The injured employee should provide written notice as early as possible within the stipulated deadline period. With an illness that is work-related, the employee should report to the employer as soon as the symptoms start to occur.

2. The Employer Provides Necessary Paperwork and files the claim

After the employee has informed the employer about the accident, he/she should be provided with relevant information concerning the insurance provider, rights and benefits of workers’ comp, and the return-to-work formula. If possible, all this information should be made available before the injured employee is admitted to the hospital. Failure to provide this crucial information can open the window for lawsuits which may turn costly to the organization.

Once all the paperwork has been correctly done, it is now the time of the employee to submit them to the workers’ comp insurance provider. The paperwork should be filed together with the doctor’s medical report. Additionally, the employer should file a copy to the state workers’ compensation board to make them aware of the situation at hand.

3. The Insurer Reviews the Claim

This is the point where the insurer can approve or deny the claim. Clear scrutiny is done on the request to ensure that the injury is work-related and there is no malice practice behind it. If the insurer thinks that the claim doesn’t meet the compensation standards, it will be denied. The employee can then request for a review or appeal on the judgment via the available legal frame work.

If the insurer approves the claim, the employee can settle on a payment offer that will help him/her to settle the medical bills associated with the injury. However, if the employee has already paid the bills, he/she can be paid a lump sum to the tune of the costs incurred.

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