A workers’ compensation claim begins when an employer reports a work-related injury or illness to their insurance company. From there, a claims adjuster will review the details and determine what benefits apply. Speed matters: most states have deadline requirements for filing workers’ comp claims, and missing them could result in denied benefits or fines for your business. This guide walks you through the claims process step by step, including how to file a claim with ERGO NEXT and what to expect. Jump ahead to learn:
How to file a Workers' Compensation claim
What to do after a workplace injury — and how to file a claim with ERGO NEXT, step by step.
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When should an employer file a Workers’ Compensation claim?
File as soon as an employee’s injury is reported to you. Don’t wait for a diagnosis or a full investigation. Most states require employers to report workplace injuries to their insurance company within a specific window, some between 24 hours and a few days after the incident.
Some states also require you to report the incident directly to a state agency within a set timeframe.
Late filing can delay benefits for your employee and trigger compliance penalties for your business. When in doubt, report immediately and let your insurance company help you gather the details.
The four most common types of Workers’ Comp benefits
The type of claim you file and the compensation an injured employee may receive vary depending on the type and severity of the injury or illness.
There are four main types of workers’ compensation benefits that may apply:
1. Medical expenses
A medical services claim can help cover expenses related to injuries and illnesses, including bills for doctor’s visits, surgery, physical therapy, prescriptions and other expenses.
For example, a heavy object falls off a shelf and injures your employee. They’re in too much pain to keep working, so they head to the doctor to get it checked out. Surgery is required to treat the injury, plus eight weeks of physical therapy to regain mobility. A claim could help pay for treatment, physical therapy and medication.**
2. Loss of income
Now, let’s assume the injury is severe enough that the employee cannot return to work until they’ve completed medical care and all eight weeks of physical therapy. A loss of income claim could help with wage replacement while they’re unable to work.
3. Disability benefits
If an injury turns out to be so severe that the employee can no longer work at all — even in a different job with different responsibilities — permanent disability benefits may provide compensation, depending on the severity of the injury, state regulations and claim determination.
4. Death benefits
If an employee experiences an incident that’s so serious it results in death, the employee’s beneficiaries could receive death benefits to help cover funeral expenses up to the policy limit, and their dependents could receive survivor benefits.
How to file a Workers’ Compensation claim with ERGO NEXT
It’s distressing enough to have an employee get injured on the job. We understand that filing a workers’ compensation claim can feel overwhelming and disruptive — that’s why we work to make filing workers’ comp claims straightforward.
Here’s the general information you’ll need if you or one of your employees is injured at work and you have workers’ compensation coverage with ERGO NEXT:
1. Contact our claims team
Call us at (855) 222-5919 as soon as possible after the accident occurs.
Claims must be filed within a specific timeframe. The exact timeline varies by state, but it’s important to act quickly so you don’t miss the filing window for benefits that may be available under your policy.
Once you file a claim, one of our claims advocates will complete a workers’ compensation claim form — also known as the first report of injury — to gather details about the employee and what happened to cause the injury or illness.
You’ll be asked to provide some basic information including:
- Basic employee information, including the employee’s name and contact details.
- The name your insurance policy is under, so we can locate the correct policy.
You’ll also be asked to share as many details about the incident as possible, including:
- Where it happened
- When it happened
- What the employee was doing
- What type of injury they sustained
If you have photos, witness statements or information about the treatment they received, that’s helpful, too. The more information you can provide, the better.
If the employee was injured while operating a piece of equipment, it’s important to leave it where the accident occurred. There could be an investigation into the source of the injury.
2. Speak to a claims adjuster
After you provide the initial incident report information, a claim is created and a claim number is generated. This process can take up to 24 hours.
A dedicated claims adjuster is assigned to your claim and will investigate whether it should be approved or denied.
During the process, the adjuster will follow up with you and the injured employee to get statements and any additional information. They may ask some of the same questions you answered when you called to report the claim to confirm the information they received is correct.
The adjuster may also request any new information that becomes available during the investigation.
If the injured worker received medical treatment, the adjuster may contact the provider to obtain medical records and determine whether ongoing treatment is needed.
For wage benefits, you’ll need to provide wage statements for the employee. Most states require either 13 weeks or 52 weeks of statements to determine the lost wage benefit.
If you live in a state that requires workers’ compensation claims to be reported to the state’s insurance regulatory agency, your ERGO NEXT adjuster will take care of that for you.
3. Receive a decision
Once the adjuster collects the necessary information and statements, it takes about one to two weeks to receive a claim decision. If the adjuster isn’t able to get the necessary information, it could take longer to receive a decision.
If the claim is approved, covered benefits can help pay for eligible medical expenses, lost wages and other benefits available under the policy and applicable state law.
If the claim is denied, the adjuster will let you and the injured worker know, and we’ll send a letter that explains why the claim was rejected.
If the injured worker disagrees with the decision to deny the claim, they may contest the denial with the state division of workers’ compensation that manages claims where the injury occurred.
Workers’ comp claims can be expensive. The average cost for workers’ compensation claims was $47,316 in 2022-2023 (which is the latest data available from the National Council on Compensation Insurance). That’s a significant, unplanned expense. To protect your small business, we highly encourage you to make sure you have the coverage you need and to follow the recommended steps for a smooth claims process.
How ERGO NEXT helps business owners with Workers’ Comp coverage
ERGO NEXT is 100% dedicated to helping small businesses and self-employed workers find the right business insurance, with our quick and easy online quote process.
We’ll ask a few questions about your business and give you a quote. You can select your coverage options and buy your policy — all in about 10 minutes. Your certificate of insurance will be available immediately, and you can access your policy 24/7 via web or mobile app.
If you have questions, our licensed, U.S.-based insurance professionals are available to help.
Workers' Compensation claim FAQ
Get answers to the most common questions about how to file a workers’ comp claim.
Who files a Workers' Compensation claim? The employer or the employee?
Both the employer and employee typically have roles in the workers' comp claims process. The employee reports the injury to the employer, and the employer is responsible for notifying the insurance company and initiating the claim. The insurer will then get the process rolling by assigning a claims adjuster who will request all the necessary information. In some states, the employer is also required to report the injury directly to a state workers' compensation agency within a specific timeframe.
What is the first report of injury in a Workers' Comp claim?
The first report of injury is the official form that documents the details of a workplace accident. This is the document that initiates the workers' comp claims process. Typically, this report captures information about the incident including details about the employee, the date and location of the injury, what the employee was doing when the injury occurred and what type of injury was sustained. At ERGO NEXT, a claims advocate works with you to complete this form once you’ve reported an incident.
How long does a Workers' Comp claim take to process?
There’s no set timeline for how long a workers’ comp claim can take, from initial filing to the decision. A lot of it depends on how quickly you can gather and share all the necessary information. With ERGO NEXT, you'll typically speak with a claims adjuster within 24 hours of reporting an incident. A claim decision generally takes about one to two weeks once the adjuster has received medical information and statements from both the employer and the injured employee. But if information is missing or disputed, the claims process may take longer.
What happens if a Workers' Comp claim is denied?
If a workers' comp claim is denied, the insurance company must provide a written explanation of the reason. The injured employee can contest the denial through the state's division of workers' compensation where the injury occurred. Common reasons a claim may be denied include an injury that is not work-related, a claim filed after the state deadline or insufficient documentation. To ensure your best chance of a successful claim, you’ll want to file as soon as possible, keep thorough records and follow all the necessary steps in the claims process.
Can an employee file a Workers' Comp claim without employer involvement?
The standard process for filing a claim starts with the employee notifying the employer, who then reports to the insurance company and any required state agency. But in most states, employees can file a workers’ comp claim directly with the state workers' compensation board if the employer fails to report the injury or disputes the claim. Employers who fail to report a workplace injury — or who discourage an employee from filing — can face serious legal and financial consequences.
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* To the extent permitted by law, applicants are individually underwritten, not all applicants may qualify. Individual rates and savings vary and are subject to change. Discounts and savings are available where state laws and regulations allow, and may vary by state. Certain discounts apply to specific coverages only.