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Understanding workers' insurance

Workers’ compensation insurance is a type of insurance that is mandatory for nearly all businesses. Its purpose is to compensate employees who have sustained covered injuries, illnesses, or fatalities while completing work-related duties.

Workers’ comp is typically “no-fault” insurance. This means that it does not matter whether a workplace accident was the employee’s or the employer’s fault. This helps shift the focus away from blame and liability and keeps the emphasis on the injured worker’s medical treatment and recovery.

Robust workers’ insurance plans can help companies manage workplace risks and underscore the importance of workplace safety. CompSource Mutual, Oklahoma’s premier workers’ compensation insurance provider, offers a wide range of resources to help businesses meet safety requirements and maintain healthier workforces. Learn more here.

However, accidents do happen, and it is important for employees and employers to know how to file for workers’ comp and what protocols to follow to make a workers’ comp claim. Medical compensation through workers’ comp may not be approved if a claim is not submitted quickly enough or if there is not enough documentation. This is why it is critical for employers to discuss these procedures with both their insurance companies and their employees.

How to file for workers’ comp

It is important to file for work injury compensation as soon as an accident occurs. This may seem like common sense, but there are many reasons why an employee might not file a claim immediately, including: thinking the injury isn’t “serious” enough, hoping it goes away, fear of repercussions, or a lack of understanding about how workers’ insurance functions.

As soon as an employee is injured or becomes ill due to work-related duties, they should tell their supervisor and file an incident report. The employee should include as much detail as possible about the accident or illness, including any documentation, such as timesheets, vehicle logs, photographs, or videos. All of this information could be useful to the workers’ compensation insurance company.

After receiving immediate reporting and documentation from the employee, the employer or supervisor should be ready to file additional information to send to the insurance company. Some important things to consider might be:

  • Has or will the employee miss time from work due to the injury?
  • Where did the employee go for treatment, and what is the address and/or phone number of the treatment facility?
  • Were there any witnesses, and did they fill out a witness report?
  • Is light duty available?

The term “light-duty” refers to a modified version of the job the injured or ill employee was doing before the incident. This may mean fewer hours, sitting instead of standing, or a less physically intense version of the same job. It could also mean a slightly different, less demanding job that the employee does not need full retraining to complete, such as working on administrative tasks instead of working in the warehouse. It is important to determine if light-duty work options are available, as it may impact what kind of workers’ compensation benefits the employee receives. If the employee is able to complete a “light-duty” job, they may not be eligible for certain types of workers’ compensation disability payments.

The employer or supervisor should know how to file for workers’ comp. If they are unsure, they should call their insurance company immediately, so no time is lost after the incident occurs.

CompSource Mutual policyholders can file claims on the online portal and over the phone at (800) 872-7015. Learn more here

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Receiving medical care

Once the claim has been filed with the insurance company, the insurance company representative, also called a “claims adjuster,” will work directly with the employer to help coordinate and facilitate medical care.

At CompSource Mutual, we can connect you with quality medical care and pharmacy resources to aid in recovery and foster a successful return to work. Learn more about How the Claims Process Works from A to Z.

Like health insurance companies, workers’ compensation insurance companies typically have networks of doctors and pharmacies. Not all doctors are “in-network,” so it is critically important to coordinate medical care directly with the insurance company to ensure that the treatments and prescriptions are properly covered.

If an urgent injury occurs at work, call 911 or go to an emergency care facility. For non-emergency injuries, CompSource Mutual has a 24/7 registered nurse advice line. Policyholders who have questions about coordinating non-urgent medical treatment for employees can call (855) 310-5448.

Learn more about the 24/7/365 Nurse Advice Line here

Policyholders or injured workers can also always contact our dedicated team of claims adjusters, particularly if they are not sure how to file for workers’ comp or if questions arise about specific claims.

Injured workers can learn more about their benefits here.

Why CompSource Mutual

At CompSource Mutual, employee safety is our top priority because we believe that Oklahoma’s greatest asset is its people. Contact us to file a claim early, as we have a robust network of resources available to support your workers and your business in the event of a covered workplace injury.

Our experienced team is trained to guide you through the workers’ compensation insurance claims process from start to finish – making it simple and straightforward. Visit our Claims page to find out more about how to file for workers’ comp, and what happens after a claim has been filed.

We’ve been supporting Oklahoma businesses for more than 85 years. As the Sooner State’s long-standing Oklahoma insurance provider, CompSource Mutual is uniquely qualified to offer top-notch workers’ comp protection to businesses at a fair price.

Learn more about the CompSource Mutual claims process here.

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Need a copy of your Certificate of Insurance? Fill out this form now.

Depending on the state and occupation, an employee may be entitled to compensation if they are injured at work. Employees who are engaged with an employer’s business and suffer injury in accidents in the course of their employment may be entitled to compensation through workers’ compensation insurance. There are some exceptions to this rule, such as if the employee is not technically on work duty while the accident occurs (e.g., during lunch break) or if the employee is found to have been intoxicated or under the influence of drugs when the incident took place.

Workers’ comp fraud is uncommon. When it does happen, there are three main categories: claimant fraud (when the employee makes a fraudulent claim), premium fraud (when the employer makes a fraudulent claim), and provider fraud (when there is fraud on the medical or legal end of the claims process).

Learn more about workers’ compensation claim fraud here

If an employee is injured, the employer is responsible for making sure that a First Report of Injury, also known as a First Notice of Injury – or FNOI, or other similar documents, are completed according to the workers’ compensation carrier’s procedures. In addition, the employer is responsible for ensuring that they do not violate any laws or the injured employee’s rights. The employer is also responsible for knowing how to file for workers’ comp and understanding the processes and paperwork required.

According to OSHA Standard 1904.5, an injury is defined as “work-related” if an event or exposure in the work environment either caused or contributed to the injury or significantly aggravated a pre-existing injury or illness.

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