What Is a Workers’ Compensation Claim?

  • Published Dec 10, 2020

In any business greater than one, there’s a risk of employee injury or illness on the job. And when injury happens, employees who don’t have financial help are likely to find themselves with significant debt as a result of mounting medical bills and lost wages. Plus, businesses may be subjected to personal injury lawsuits from injured employees who are seeking damages, causing financial distress to the business that can be difficult to recover from.

A simple slip on a wet tile floor can spell financial disaster.

Luckily, workers’ compensation insurance offers protection to both the employee and the employer by covering expenses related to on-the-job injuries, including short- and long-term medical bills, lost wages, and legal fees related to workplace personal injury lawsuits. Below, we’ll go over what a workers’ compensation claim is and cover some common questions regarding the workers’ comp claim process.

What Is a Workers’ Comp Ghost Policy?

A workers’ comp ghost policy is an affordable type of workers’ compensation insurance specifically designed for independent contractors who don’t have any employees but require proof of workers’ comp coverage for their state’s legal requirements or client requests.

What Is a Workers’ Compensation Claim?

A workers’ compensation claim is an insurance claim that is filed through a business’s workers’ compensation insurance provider. Its purpose is to help cover the costs related to a workplace injury or illness.

By filing a claim, an employee is alleging that the injury or illness is a direct result of their employment and is holding the business liable for covering the costs related to the injury. As with other types of insurance, businesses have workers’ compensation to help cover those costs. Once a claim is filed, the workers’ comp claims process begins, and the claim is either approved or denied.

What Is the Workers’ Compensation Claims Process Like?

Although the workers’ comp claims process can differ depending on the state, for the most part, the process goes like this:

  • 1. Following a workplace injury, the employee must act quickly to report the injury or illness to their employer.
  • 2. The employee will then receive the proper workers’ comp paperwork from their employer, fill it out, and submit it back to the employer.
  • 3. Once the paperwork is submitted, the employer submits the paperwork to their insurer, officially filing the claim.
  • 4. Once the workers’ comp claim has been received by the insurer, the insurance adjuster assigned to the claim assesses the situation using all available evidence and either approves or denies the claim.
  • 5. In the event of approval, the insurer will contact the employee with details about payment. The employee can choose to accept the amount offered or pursue legal action if they feel the funds are insufficient.
  • 6. In the event of a denial, the employee can choose to either accept the determination, ask the insurance company to review its decision, or pursue legal action.
  • 7. Once a determination and agreement have been made between the employee and the insurance company, the employee must notify their employer as to when they can return to work.

How Long Does the Workers’ Compensation Claims Process Take?

Every employee, business, and workplace injury or illness is different. Additionally, every insurance policy and company’s protocols are different. That said, the length of time a worker’s comp claim can take from start to finish varies greatly depending on the unique circumstances of each claim.

For example, a claim in which the employee does not accept the compensation amount offered by the insurer will take significantly more time than instances in which the employee deems the compensation amount sufficient. The claim timeline also depends on the severity of the injury or illness. Complicated injuries and their long-term effects can require more time to determine a compensation amount.

How Much Does Workers’ Comp Insurance Cost?

Workers’ compensation insurance premiums are based on multiple factors, such as the industry and state in which a business operates in, the workers’ comp claim history of a business, and other factors that are unique to each business.

However, compared to the costs associated with being held liable for an employee injury, which includes medical expenses, lost wages, and legal fees, many business owners find workers’ compensation insurance premiums worth the investment. And many find that workers’ comp insurance is more affordable than expected once they get an online quote.

Cerity — A New Approach to Workers’ Comp

Cerity is a faster, more affordable, and more flexible way to get workers’ comp insurance. We offer comprehensive coverage that is quick and easy to sign up for. Our innovative online quote tool provides instant quotes and immediate coverage so business owners can focus their time and attention on more important things. To get a free quote online, visit our workers’ comp quote tool today.

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The information provided is intended to provide a general overview. This information is not legal advice and should not be relied on as such. Cerity® makes no warranties for the accuracy, adequacy, or completeness of the information provided, and will not be responsible for any actions taken based on the information contained herein. If you have legal questions or need legal advice, please consult an attorney.