Workers’ compensation benefits are a vital safety net for employees who sustain injuries or illnesses while performing their work. Sadly, often the claims process appears to be complicated and overwhelming to injured workers. According to the viewpoint of Charles Spinelli, familiarity with the functioning of the claim process is key for employees to get benefits owed to them and also for employers to stay compliant with the law. This guide highlights the key steps of workers’ compensation claims.
Step 1: Immediate Reporting of the Injury or Illness
Reporting the injury or illness is the foremost phase in the workers’ compensation process. The employees should report to their employer immediately after injury. In most states, an injury should be reported within a given duration, usually between 24 and 72 hours, to be eligible for benefits. It is also crucial for workers to give as much information as possible, such as the circumstances under which the injury occurred, the time, the types of injuries, and whether they have received the medical care.
Employers ought to have well-defined procedures to report injuries and encourage employees to report incidents quickly, even in cases where it appears that the injury is minor. Early reporting leads to efficient handling of claims, and there’s less chance that claims will get delayed or rejected.
Step 2: Medical Evaluation
After reporting to the employer, the injured or ill worker should meet a doctor for immediate medical intervention. In general, the employer should be equipped with a pre-recommended list of medical practitioners provided by the insurer for the employee to seek treatment. According to Charles Spinelli, It is wise to get in touch with those pre-approved doctors only under the network, other than any exceptional incidence.
The employee needs to follow the doctor’s advice and maintain a record of all medical visits and treatments. Employers should provide access to medical care and ensure that the employee is supported by ambulance and resources to receive necessary treatment.
Step 3: Filing the Claim
Make sure to furnish a formal claim for workers’ compensation. This is often done by completing a claim form to be available with the employer as provided by the employer’s insurance carrier. The employer should support in completing the claim so that all required entries and documents are duly attached and filed in time.
Employees should be careful to provide full and accurate details of the incident to ensure that the claim is not delayed. Discrepancies or incomplete forms can lead to denials of claims or long waiting.
Step 4: Claim Review and Approval
After filing the claim paper, the insurance company will review all information, such as the medical records, the type of injury, and the incident surrounding the injury. The insurance company will assess if the injury can be compensated under state laws. If the claim is passed, the employee will start receiving benefits, such as medical expenses, wage replacement, and other related expenses.
Last but not least, employees must remain in contact with their employer and physician, reporting progress towards recovery and predicted return-to-work date. Where the employee is not in a position to be back full-time, benefits on a temporary disability basis can be paid until ready to perform usual duties.
