workers comp claims

A basic understanding of workers compensations rules follows the reasoning that employees who get hurt while on company time or a company job can seek treatment and have their medical expenses paid for by the company’s workers comp policy. Though it seems simple, the rules governing qualified incidents and covered services can be complex. As an employer, it is your legal responsibility to have the rules of your workers comp policy and process posted all over the workplace for employee understanding.

Corporate and Personal Responsibility

The primary responsibility of reporting an workplace injury or work-related illness falls with the employee. While it may be obvious that an incident has occurred if an employee is rushed to the hospital with a severed limb or broken bone, it is still the employee’s job to fill out a claim form. If you know about the situation, you can proactively provide them with the forms to complete. Employees must also comply with the reporting period that has been posted with the workers comp information and allowed by the state. Incidents that are not reported or not reported within the required timeframe may have justification for a corporate refusal to file.

Once the injured employee has made the report, the legal obligation of the employer begins. At this point, you are to provide the employee with all of the forms needed to make a formal report of the injury. There is a responsibility to provide the employee with a list of medical providers and facilities that are covered through the workers comp plan. When the completed paperwork is in hand, the employee must notify the state’s workers comp board. You also have a timeline for submitting this information, though it varies from state to state.

Penalties for Failing to Report

Failing to submit the paperwork can result in steep fines, depending on the injury. Fines could be assessed in the hundreds to thousands of dollars from the state board, but it possible for more serious consequences to ensue. The business owner or corporate executive could be given misdemeanor charges with potential jail time. In these cases, criminal fines could be leveled against the offender as well. In addition to state penalties, the employee who was denied workers comp benefits could file a lawsuit for the expenses and damages incurred throughout the ordeal.

Corporate Leeway

There are validations for refusing a claim, though these need to be carefully assessed. Possible reasons include:

  • The injury did not need medical attention
  • The employee was not hurt from a work-related incident
  • The employee filed a false claim
  • The reporting deadline had elapsed
  • The injury did not justify time off work

Your decisions in areas of workers comp claims could be contestable, so be sure you know what the law requires in each situation. There can be serious consequences if you fail to honor your policy and file a claim for an employee.

About InsureMyWorkComp 

InsureMyWorkComp is a digital brokerage that helps clients find the right workers’ compensation solution for their business needs. Unlike other online platforms, we will help you to work with an agent who can provide you the right solution for your risk profile. Our staff has over 50 years of workers’ compensation underwriting and sales experience, and we are 

confident that we will provide you the support that you need. For more information or to get a quote, contact us today at (855) 340-9138.