When an employee is injured on the job, what are they responsible for? What happens during the work comp claim process? In this blog post, we will be speaking to employees about their responsibilities. Note* some things are subject to change based on individual companies procedures and policies.
Utilize Your Company’s Medical Treatment Plan
How you handle the injury matters. First things first, asses the severity of the injury. If the injury is an emergency, call 911 and use the company’s network medical providers.
If your injury is not severe, you can do one of two things:
- Option one, seek onsite first aid treatment then immediately report your injury to your employer.
- Option two, if your company has a nurse triage program, call the hotline number. Once proper treatment is given, immediately report the injury to your employer.
TIP: Report the incident or near miss no matter how small. This can prevent future accidents or help with future documentation.
Now the claims process can begin.
1. Report the injury promptly
An injured workers first responsibility is to report that injury or incident to your employer, preferably within the first 24 hours. Timely reporting helps ensure that you remain eligible for benefits and that you receive proper treatment before your injury worsens.
We recommend that your report is in writing and that you keep a copy for your records.
TIP: Each state has different reporting timelines. Make sure you verify that timeline with your employer, so you don’t miss out on benefits.
2. Cooperate with all parties
The best thing you can do is cooperate with the insurance carrier, your employer, medical professional, and any designated representative handling your claim. Denying requests or intentionally making the process difficult can poorly affect your claim.
TIP: The insurance carrier may request an independent medical examination (IME). Just know that this is common, following through with the examination will show your cooperation.
3. Act Ethically
Keeping ethics top of mind during the claims process is key. Here are a few dos and don’ts:
- Don’t falsify information or create misleading statements
- Don’t exaggerate the extent of your injuries
- Do cooperate with private investigators that are sent by carriers
- Do create your own file with records and reports to keep the facts straight
TIP: Know that private investigators are common. They are hired to make sure your claim is not fraudulent. Therefore, it is important to always tell the truth.
4. Follow medical restrictions at work and home
Your doctor should provide you with guidelines that are applicable to your condition. The doctor may advise medical leave or put restrictions on your workload.
It is important to follow your physician’s instructions so that you can recover and reduce further injury. Participating in any activities that can aggravate the injury can cause a major setback.
At this time, you may be asked to help develop a return-to-work plan that fits your employers needs and your own. Based on your medical restrictions, light duty work may be assigned or modifications will be made to your current position.
TIP: Try to stay positive. Light duty assignments, like ordering supplies or answering the phone, doesn’t last forever. The goal is to get you back to work and establish normalcy in your life.
5. Maintain a constant stream of communication
While your work comp claim is active, it is important to maintain a constant stream of communication. Communicate with interested parties if you cannot perform your job duties, make your doctor visits, or any other worsening on your condition.
Recap
Agents – if you have a client/prospect who needs help with the work comp claim process, now is your time to step in and help them improve it. Our software has resources that can help you communicate the importance of proper claim reporting, employees responsibilities, medical treatment plans, etc.
Business Owners or HR – Letting your employees know what is expected of them during the claims process is key. Speak with your agent or a work comp professional about what that process looks like and how to educate your employees.
Reach out to our team at [email protected] if you have any questions about the work comp claim process.