What is a Workers’ Comp claim?
A workers’ comp claim is how you request benefits on your workers’ compensation insurance after an employee gets hurt or sick on the job.
Workplace injuries are common — private industry employers reported 2.5 million nonfatal workplace injuries and illnesses in 2024, according to the U.S. Bureau of Labor Statistics — which is one reason most states require employers to carry workers’ compensation insurance.
If an employee has an on-the-job injury or becomes ill at work, a workers’ comp policy can help cover:
- Medical care, prescriptions and rehabilitation services
- A portion of lost wages during recovery
- Job retraining after an injury
- Benefits for permanent injuries
- Death benefits for surviving family members after a fatal workplace injury
To access these benefits, the employer and injured employee typically need to file a workers’ comp claim. Filing a claim means the employee or employer reports the incident to the insurance provider.
In states where workers’ comp is required, the insurance provider reviews the claim and determines what benefits may apply, and for how long.
What are common Workers’ Compensation insurance claims examples?
While some types of work environments might seem to be much higher risk, incidents that result in a workers’ comp claim can happen anywhere. Here are a few common workers’ comp claim examples.
1. Medical costs for workplace injuries
If an electrician is injured on the job and needs emergency room services, several weeks of hospital care and a month of rehabilitation, workers’ comp could help.**
Workers’ compensation coverage could help pay for medical costs and a portion of the electrician’s lost wages until they return to work.
2. The expense of long-term recovery and rehabilitation
Some serious injuries require ongoing care. Workers’ compensation insurance could help replace part of an employee’s lost income during recovery and help cover rehabilitative care, medications and follow-up doctor’s visits.
If one of your painter employees suffers wrist and ankle fractures and a sprained back, a workers’ compensation policy could help cover medical expenses and physical therapy while they recover.
3. Repetitive stress or overuse injuries
Not all workplace injuries happen suddenly. Some develop over time due to repetitive motion or strain.
For example, a business consultant who develops carpal tunnel syndrome or a retail shop worker with chronic back pain caused by sitting at the register may be eligible for workers’ comp benefits to help cover treatment and time away from work.
4. An employee suffers a disability from a work-related accident
In more serious cases, a workplace injury can lead to a temporary or permanent disability. Workers’ compensation insurance could help cover ongoing medical care and provide financial support if an employee can’t return to work right away.
If a construction worker is exposed to toxic chemicals at a construction site and suffers a serious eye injury, ongoing medical care — with its associated ongoing medical bills — could be covered by workers’ comp to help them recover from a temporary or permanent loss of vision.
5. Job retraining after a workplace injury
If an employee can’t return to their previous role after an injury, workers’ compensation insurance could help cover job retraining or education for a new position.
For example, if a house cleaner develops a long-term back injury from work and can no longer perform physical labor, workers’ comp may help cover training for a less physically demanding role.
6. An accidental fatality while on the job
In rare but serious cases, a workplace accident can result in death. Workers’ compensation insurance could help cover funeral or burial costs and provide financial support to the employee’s family or dependents.
Fatal workplace injuries can happen in situations such as falls, heavy equipment accidents or car accidents on the job.
What are the most common causes of Workers’ Comp claims?
Many workers’ comp claims stem from a few common types of workplace incidents.
Overexertion and repetitive motion injuries are the most common cause of workers’ comp claims, followed by contact with objects or equipment and slips, trips and falls. These incidents combined account for the majority of workplace injury incidents each year in the U.S., according to the National Safety Counsel (NSC).
The 7 most common causes of workplace injuries in the U.S.
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What it means
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Example
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1. Contact with objects or equipment
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Being struck by, caught in or compressed by tools, machinery or materials
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A worker is hit by falling equipment or caught in machinery
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2. Overexertion and repetitive motion
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Strain from lifting, pushing, pulling or repeated movements
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A warehouse worker injures their back while lifting heavy boxes
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3. Falls, slips and trips
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Losing balance on surfaces or from heights
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An employee slips on a wet floor or falls from a ladder
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| 4. Exposure to harmful substances or environments
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Contact with chemicals, extreme temperatures or hazardous conditions
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A cleaner is exposed to strong chemicals and develops respiratory issues
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| 5. Transportation incidents
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Accidents involving vehicles used for work
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A delivery driver is injured in a vehicle collision
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| 6. Violence or injuries caused by people or animals
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Physical harm caused by another person or animal
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A healthcare worker is injured by a patient
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| 7. Fires and explosions
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Injuries caused by combustion or hazardous materials
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A worker is burned in a workplace fire or explosion
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Source: National Safety Council (NSC), Injury Facts 2023–2024 data
How long do you have to file a Workers’ Comp claim?
Employees must report a work-related injury or illness to their employer as soon as possible. State laws set different deadlines, but employees often need to give notice within 10 to 90 days.
Because requirements vary by state, it’s important to check your local labor laws.
It’s a good idea to keep written documents of all incident reporting just in case it’s needed later on.
Be sure to keep track of:
- The date of a specific accident or injury.
- The date an employee learned of their injury, such as a repetitive injury.
- The date of a doctor’s diagnosis of injury or illness.
Employers should include workers’ comp notice requirements in their employee handbook so workers know exactly what to do after they get hurt or sick.
Once an employee reports the injury or illness, the employer typically needs to notify the insurance company and begin the claims process as soon as possible. This step often includes written documentation from a doctor.
Claim deadlines also vary by state, but businesses may have anywhere from one to three years to submit a claim to the insurance provider.
How do I file a Workers’ Compensation claim with ERGO NEXT?
If you or one of your employees has a work-related injury or illness and you have an ERGO NEXT workers’ compensation policy, here’s how to start the claims process:
- Connect with our claims team. Log in to your account to report the incident.
- Talk to our adjuster.
- Review the outcome. We try to resolve claims in one to two weeks, but claim resolution times vary.
Learn more about how to file a workers’ comp claim with ERGO NEXT.
How do I know if my ERGO NEXT Workers’ Comp claim is approved?
If the claim is approved, ERGO NEXT may help cover treatment, lost wages and other eligible benefits based on your policy.
If the claim is denied, the adjuster will notify you and the injured worker and provide written documentation explaining the reason for the denial. The denial can be contested with your state’s labor department or division of workers’ compensation.
