How to file a Workers' Compensation claim

The average cost of a workers’ compensation claim can be more than $40,000, according to the National Council on Compensation Insurance. That’s a significant, unplanned expense for small businesses.

When you have workers’ compensation insurance, employers and employees have protection. It’s important to understand how to file a claim if an employee experiences a work-related injury or illness.

Jump ahead to learn:

• What is a Workers’ Compensation claim?
• The four types of Workers’ Comp claims
• How to file a Workers’ Compensation claims with NEXT
• How NEXT helps business owners find Workers’ Comp coverage

What is a Workers’ Compensation claim?

If one of your employees gets injured on the job or experiences a workplace illness, you must file a workers’ compensation claim with your insurance carrier to receive benefits under your policy.

It’s important to notify your carrier immediately after the incident so you can get help with resolving the issue and avoid unnecessary complications.

It’s generally best to file your claim as soon as possible, even if you are still gathering facts and information. Many states also have deadline requirements within a few days of the incident. Missing these deadlines can potentially result in fines for your business.

The four types of Workers’ Comp claims

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

1. Medical expenses

A medical expense claim can help pay for treatment 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 cover medical treatment, physical therapy and medication expenses.

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 can help with wage replacement while they’re unable to work.

3. 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.

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 cover funeral expenses up to the policy limit, and their dependents may receive survivor benefits.

How to file a Workers’ Compensation claims with NEXT

We understand that a workers’ compensation claim can be frightening, stressful and disruptive to your business — especially if it involves workplace injuries.

We work hard to make the process as quick and easy as possible for you and your employees.

Filing for workers’ comp benefits with NEXT 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.

An open line of communication between you and our team will also help move the process forward.

Here’s what you need to do if you or one of your employees are injured at work and you have a workers’ compensation policy with NEXT:

1. Contact our claims team

Call us immediately at (855) 222-5919 to report the incident immediately after it occurs.

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:

• The employee’s name, date of birth and social security number and contact information so we can review their 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, 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 using 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 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.

An adjuster is assigned to the 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.

If new information is available since the incident was first reported, they will also need that.

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

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 NEXT adjuster will take care of that for you.

3. 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 information and statements from you and the employee. If they’re unable to get the information they need, it may take longer.

If the claim is approved, NEXT will pay for treatment, lost wages, and any other approved benefits in your policy.

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.

How NEXT 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 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). Our licensed, U.S.-based insurance advisors are ready and waiting to help.

Start your instant quote today.

This article was reviewed by Michael Coyle, Workers’ Compensation program manager at NEXT.