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What To Do If You Think You Have A Claim

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Employers who are not exempt from providing workers' compensation insurance benefits for employees are required by law to post information about reporting requirements in a readable format in a prominent place on the employer's premises. It is the employee's responsibility to read the information and understand his or her role in the workers compensation claim process, especially the injury reporting process.

In the event of an injury or occupational exposure that results in illness, the employee has a limited amount of time to report the incident to a supervisor or designated representative of the employer. Most of the time, the employer's representative will be required to produce a written statement and supply the employee with a copy. An insurance claim adjuster will be assigned to the case. The employee will either be contacted by the claim adjuster within a specified amount of time or provided with a phone number to call the adjuster.

After reporting the injury, the employer or insurance company may select and direct an employee to an occupational physician or medical care facility. At this time, the employee does not have a right to be seen by his or her personal provider. Personal health insurance will not cover any expenses related to the work-related injury. The physician is contracted by the employer to examine, treat and report information about the employee's injury. The occupational physician's report will be key in determining the claims outcome.

Part of the claim adjuster's responsibility will be in advising the employee of his or her rights under the law. It is, however, always in the employee's best interest to be as fully informed as possible if he or she feels that the claim is not being handled appropriately. If an employee is not satisfied with the assigned medical provider, he or she may contact the assigned claim adjuster and request a different doctor or a second opinion. Approval must be obtained in advance or the expense will not be covered. In some states, after a specified amount of time has passed, an employee may have his or her medical or care taken over by a personal health care provider.

Eventually, a claim will need to be classified into a system that will determine how much the claim is worth and the duration of responsibility. All injuries need to be identified as being permanent or temporary, and determined to be a total or a partial disability. Payment for medical care, lost wages, and vocational rehabilitation will be directly related to this classification. However, the classification may be changed at some point during the claim process if a new diagnosis is forthcoming. Some payments may be made incrementally, some in a single lump sum, or some in multiple lump sums. This process is also governed by the individual state's laws.