What is the workers’ compensation claim process?

Workers’ compensation laws have been formulated providing benefits to the employees facing workplace injuries or illnesses and the Tampa workers’ compensation attorney are the ones to handle such cases. The employees and employers both are benefitted. Workers injured on the job receive benefits covering medical expenses, lost wages and much more whereas employers are able to provide comprehensive compensation coverage to their employees. There is no chance of any legal action from the employee’s side if they are duly compensated and the business is also not held liable to cover the expenses out of its pocket.

Workers who have suffered injuries or illnesses while doing their job should file for the workers’ compensation as per the law. First make sure that the company has a workers’ compensation insurance policy in place. Secondly the worker should be an official employee of that company and not an independent contractor. Lastly the injury or illness should have occurred while the worker was on the job. Make sure you contact a good workers’ compensation attorney specializing in the field to make your case stronger.

However there are some of the workplace injuries that the workers’ comp plan doesn’t cover. The on-the-job injuries related to

• Psychiatric conditions of the worker
• Self-inflicted incidents might occur
• Accidents that occur on the commute to or from work
• Employees injured while engaging in activities that are against company policies like crime, fighting, drugs, alcohol, etc.

First step in the workers’ compensation claims process

Firstly the injured employee should receive immediate medical treatment so that they have more chance of a full recovery if they get a faster treatment. The employee should have all the medical records documented regarding their treatment in order to file for the workers’ comp claim. When the injuries don’t require an emergency care, the employee should check with the employer to see whether they need to see a specific doctor in order to be covered by the workers’ comp policy.

The employees need to inform their employers regarding workplace accident and the resulting injuries if any. The details of the event are to be sent in the form of a written notification to the employer as soon as possible. Different states have different laws but often employees have a limited window in which they can report to get the comp benefits. Even if the employee is not sure of their injury they should report the incident because if they experience any injury ramifications later they have still the chances of getting the workers’ comp coverage.

Beginning of the workers’ comp claim

An official claim begins only after the employer is notified. The injured employee fills the required reporting forms provided by the employer which includes filling the important details about the event such as the nature of the injury, where and when the injury took place , details surrounding the incident, medical treatment required in relation to the injury and more.

The next step in the claims process is taken by the employer where the claim and related paperwork is filed with their workers’ compensation insurance provider and the state workers’ comp board (depending on local state laws). The insurance company evaluates the claim after it has received the medical records of the injured employee. After evaluation the employer and the injured employee both are notified whether or not the claim has been approved.

What if a claim is denied? 

In case the claim is denied, the employees can appeal to or ask the insurer to review their decision. It’s always advisable to seek an experienced workers’ compensation attorney to handle the claiming process. They are knowledgeable persons specializing in the area and can help in a better way to receive benefits provisioned as per the law.

What if a claim is approved? 

The employees are notified about their compensation covering costs such as medical expenses, disability, lost wages and many more. The employee has a choice to accept the compensation amount through either a lump sum or a structured settlement.

After recovery the employees need to notify their employer and the workers’ comp insurance company when they will be able to come back to work. The disability benefits may or may not continue after the employee has returned to work, depending on how severe the injuries were. The businesses should take up the employee training programs and workplace policies encouraging safety in order to cut on the workers’ comp premiums or costs.

It is important for the employers and employees to follow all the steps in the claims process to ensure the best possible outcome from workplace injuries or illnesses.