What Happens After Filing A Work Comp Claim

Work Comp Claim

Table of Contents

When you file a work comp claim as an employer, several things can happen to your workers’ compensation policy. Here’s what typically happens when you file a claim:

  • Investigation: Once you file a workers’ compensation claim, the insurance company will conduct an investigation to determine the validity of the claim. They will assess the circumstances surrounding the injury or illness, review medical records, and may interview witnesses or involved parties.
  • Coverage Assessment: The insurance company will review your workers’ compensation policy to ensure that the claim falls within the scope of coverage. If the claim is valid and covered under your policy, the insurance company will proceed with processing the claim.
  • Benefits Provision: If the claim is approved, the injured or ill employee will be entitled to various workers’ compensation benefits, such as medical expenses coverage, wage replacement benefits (usually a portion of their lost wages), vocational rehabilitation if necessary, and compensation for permanent disabilities.
  • Premium Adjustment: Filing a workers’ compensation claim may impact your insurance premium. Insurance premiums are based, in part, on your claims history. Frequent or severe claims can lead to higher premiums during policy renewal.
  • Claim Costs: The costs associated with the claim will be covered by your workers’ compensation insurance policy up to the policy’s limits. The insurance company will handle the payment of medical bills and benefits to the injured employee.
  • Potential Investigations: In some cases, if there are suspicions of fraud or if the claim seems questionable, the insurance company may conduct a more thorough investigation. This is to prevent fraudulent claims and ensure that the benefits are rightly provided to those who need them.
  • Safety Evaluation: After a claim is filed, the insurance company might review your workplace safety practices and risk management procedures. Implementing better safety measures can help prevent future workplace injuries, which, in turn, can positively impact your workers’ compensation insurance costs.

It’s essential to promptly report workplace injuries or illnesses to your workers’ compensation insurance carrier to ensure a smooth claims process. Failure to report claims in a timely manner could lead to complications and potential penalties

Remember that workers’ compensation laws and processes can vary by jurisdiction, so it’s crucial to be familiar with the state specific regulations. If you have any concerns or questions about the work comp claim process, it’s best to consult with a work comp professional.