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What to Know About The Workers’ Comp Claims Process?

Jul 20, 2022

Workers Compensation

What to Know About The Workers’ Comp Claims Process?

Workers' compensation protects both the employer and the employee. With this type of insurance, employees get the medical treatment they need and eventually return to work. In return, the employee will not sue for further damages. In most cases, the accident was not caused by negligence on behalf of the employer. By working with the employee, they can return to work after the claims process has been completed.

Injury Reported by Employee

When an employee is injured in the workplace, they should notify their employer immediately. If the injury is severe, the employee may opt to have someone else notify the employer while they are taken by ambulance to the hospital. Someone should also document the scene of the accident with photographs and a written description.

Receives Medical Treatment

It is extremely important that the employee must receive medical treatment immediately after the accident. This ensures that the injuries seen in the exam result are from a work-related accident and cannot be attributed to any other health event or accident. A complete medical exam will be conducted to identify all new injuries.

Injury Reported by Employer

Once the employer receives notice that an employee has been injured, they must report the injury to their insurance carrier. The insurance carrier will call for an independent examiner to perform an additional physical examination to determine if the employee's doctor reached the same diagnosis. The diagnosis will determine the level of care and the number of benefits offered.

Employee Receives Info Packet from Carrier

Once the carrier has been informed of the accident, they will send the employee a packet that will need to be filled out by their primary doctor. The packet will explain in great detail the workers' compensation process and what the employee's next steps will be.

Claim Is Accepted or Denied by Carrier

Once the packet is filled out and returned to the carrier, they will perform a complete review and decide to accept or deny the claim. If the claim is accepted, your workers' compensation benefits will start, and the employee can begin their recovery. If the claim is denied, the employee can accept the decision or appeal it to see if they can change the carrier's decision.

Establish a Personalized Plan to Get the Employee Back to Work

If the claim is accepted, a personalized plan will be established to allow the employee the time they need to recover. During the recovery process, the employee will begin to start rehabilitation. The rehabilitation process will allow the employee to regain their strength and prepare to return to work. After the plan has been completed, the patient will be examined by their doctor and given the okay to return to work.

Claim Is Closed, and Employee Is Back at Work

Once the employee is cleared to return to work, their workers' compensation benefits will be discontinued, and their claim will be closed. The employee will return to work on a date that is agreed upon by all parties.

Learning about workers' compensation can be confusing. Contact our professionals here at Fuller Insurance Agency. We can explain the process and help you understand your rights and responsibilities when dealing with a workers' compensation claim.

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