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How to file a Workers’ Comp claim

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By Next Insurance Staff
Sep 13, 2020 min read

Having workers’ compensation insurance provides peace of mind for employers and employees alike. Your employees know you have their back if they get sick or hurt on the job. And you can rest easy knowing you are meeting your state’s requirements for workers’ comp.

According to data from the National Council on Compensation Insurance, the average cost of a workers’ compensation claim is more than $40,000. While you may hope that you never have to file a claim, accidents happen — even with the proper safety precautions in place.

That’s why it’s important to understand what you need to do to file a claim if you or someone who works for you experiences a work-related injury or illness.

What is a Workers’ Compensation claim?

You can file a workers’ compensation claim with your insurance carrier to help cover costs if you or one of your employees gets sick or hurt on the job.

It’s generally best to file your claim as soon as possible. Many states also have deadline requirements within a few days of the incident.

The different types of Workers’ Compensation claims

The kind of claim you file and the compensation the injured person receives varies depending on the type and severity of the injury or illness you or your employee experiences. There are five main types of workers’ comp claims you can file.

Medical expenses

A medical expense claim pays for treatment related to injuries and illnesses, including bills for doctor’s visits, surgery, physical therapy and prescriptions. 

For example, one of your employees works in a warehouse, and a heavy object falls and hits them on the shoulder. 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 medical claim would cover all doctor’s bills, hospital costs associated with the surgery, physical therapy expenses and medications the doctor may prescribe.

Loss of income

Now, let’s assume the injury is severe enough that the employee cannot return to work until they’ve completed all eight weeks of physical therapy. A loss of income claim can help replace a portion of their income while they’re unable to work.

Retraining

Suppose the injury is unlikely to improve with additional treatment. In that case, they can file a retraining claim, which may help pay for additional training the employee will need to perform a different job.

Permanent injury

If the injury turns out to be so severe that the employee can no longer work at all — even in a different job — permanent injury benefits may provide compensation to the employee for the rest of their life.

Death benefits

If an employee experiences an incident that’s so serious it results in death, the employee’s beneficiaries would receive death benefits to cover funeral expenses up to the policy limit, and their dependents may receive survivor benefits.

How does the Workers’ Compensation claims process work at Next Insurance?

Filing for workers’ comp benefits with Next Insurance is a straightforward process that can be completed in a few simple steps. But claims must be filed within a specific timeframe — the exact timeline varies by state — to receive workers’ compensation benefits under your policy, so it’s important to act quickly. 

Here’s what you need to do if you or one of your employees are injured at work:

 

Contact Next Insurance

Call us immediately at (855) 222-5919 to report the incident immediately after it occurs. One of our claims specialists 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: 

  • The employees name and date of birth, so that Next can pull their medical records. 
  • 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, such as where it happened, when it happened, what the employee was doing and what type of injury they sustained. 

If you have photos, witness statements or information about treatment they received, that’s helpful, too. The more information you can provide, the better. 

If the employee was injured while using a piece of equipment, it’s important to leave the equipment as is because there could be an investigation into the equipment that caused the injury.

 

Speak to an 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. 

Once the claim is created, an adjuster is assigned to the case.  An adjuster is a person who investigates the incident to determine whether the claim should be approved or denied. If it’s approved, they’ll decide how much the insurance company should pay. 

During the process, the adjuster will follow-up with you and the injured employee to get statements and additional information. They may ask some of the same questions you answered when you called to report the incident to confirm the information they received is correct. If new information is available since the incident was first reported, they will need that, as well. 

The adjuster will also reach out to the medical provider if the injured worker received treatment to get medical information and the treatment plan if ongoing treatment is required. 

The adjuster will ask if the employee is missing time from work. If they are, you’ll need to provide wage statements for the employee. Most states require either 13 weeks or 52 weeks of statements to determine the employee’s lost wage benefit. 

If you don’t have wage statements, you may be able to provide them from a similar employee, or you can let the adjuster know the injured worker’s hourly wage and how many hours they usually work each week. 

If you live in a state that requires workers’ compensation claims to be reported to the state’s insurance regulatory agency, your Next Insurance adjuster will take care of that for you. 

 

Receive a decision

It takes about one to two weeks to receive a claim decision if the adjuster can get the injured employee’s medical records and statements from you and the employee. If they’re unable to get the information they need, it may take longer. 

Next will pay for treatment and lost wages up to the limits established by your state’s workers’ comp requirements if the claim is approved. 

If the claim is denied, the adjuster will let you and the injured worker know, and we’ll send a letter in the mail 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 agency that manages workers’ comp claims where the injury occurred.  

How Next Insurance helps business owners find Workers’ Comp coverage 

We’re 100% dedicated to helping small businesses and self-employed workers find the right business insurance.

We offer a painless and seamless online experience for getting a workers’ compensation quote, purchasing coverage and accessing a certificate of insurance — all within a matter of minutes.

You can also bundle insurance coverage, such as general liability or commercial auto, to save up to 10% on your insurance costs (availability varies by state). 

Complete our online application today to see your coverage options. Our licensed, U.S.-based insurance advisors are ready and waiting to help.

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By Next Insurance Staff
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