Understanding the claims process

Insurance can be a useful tool for protecting against risks of many kinds. Workers’ compensation insurance helps protect and compensate employees who have sustained covered injuries while completing work-related tasks. In the event an accident occurs, it is important that the insurance policyholder is proactive and notifies the insurance company or files a claim.

With health insurance, the claim process mostly happens behind the scenes. The hospital or doctor’s office will contact the insurance company and file the claims on behalf of the patient. However, with workers’ compensation insurance, the process is a little different.

Workers’ comp payments kick in only after an accident or injury has occurred, so it is important that both the business owner and the employee are proactive about documenting everything related to the incident and filing the appropriate paperwork. This usually means filling out an accident report or similar document—even before an insurance claim is filed.

The business owner should know how to file for workers’ comp on behalf of their employees. If the business owner has any questions about this, they should contact their workers’ insurance company for guidance.

How to file workers’ compensation claims

Before an injury compensation claim is filed, the supervisor and employee should work together to collect as much documentation about the accident or injury as possible. The more information about the incident, the better. Without proper documentation and solid proof that the injury occurred on the job, the claim may be denied.

Some helpful types of evidence to include might be:

• Photographs of the injury
• Photographs of any damaged or faulty equipment
• Timesheets
• Video of the incident (e.g., from a security camera)
• Vehicle logs

It is important to prove that the employee was on the clock (i.e., punched in) and in the act of completing work-related duties while the accident took place.

Documenting a work-induced illness is a little more difficult. For example, a mold abatement specialist that comes down with a respiratory illness after spending two months on the job will have to prove that their respiratory illness was caused by workplace exposure. For instance, they may need to provide documentation such as:

• Medical records before and after the onset of the illness
• Photographs of insufficient protective gear, if applicable
• Evidence of any pre-existing conditions (or lack thereof)

Receiving workers’ comp benefits for a chronic illness or injury, such as carpal tunnel syndrome, is a relevant work related injury, and should be pursued if the employee is certain that their work-related duties caused it.