From Injury to Claim- A step-by-step guide to Workers’ Comp


Navigating workers’ comp can seem overwhelming. But like any undertaking, breaking down a project into systematic, digestible chunks can make your task easier and less intimidating.
Step 1
When a complaint of pain or an injury occurs on the job, it must be reported to a supervisor or manager. Injuries can be reported by the employee or observed by someone else. Every employee has a duty to report an injury that they see.
Step 2
The supervisor reports the injury to the administration level – the employer/owner, office administrator or human resources department.
Step 3
Depending on the injury, the administrative staff sends the employee for the appropriate level of evaluation or treatment to an MPN – a group of health care providers approved within the state’s WC program.
Step 4
Then the flurry of paperwork begins. A First Report of Injury form must be submitted along with any additional forms required by the state. Employees are interviewed, an investigation form is filled out, and the supervisor completes a report. Necessary forms are sent to the workers’ comp carrier as they are completed, but the First Report of Injury is submitted to the carrier the same day. Injuries should be reported immediately – within 24 hours.
Step 5
The claim is assigned a number by the carrier and the clock starts ticking. If the incident turns out to be minor, it is marked IRO (Incident Report Only) or medical only for the records. But it stays in the system in case something comes up later on the claim. If no action is taken within a year – no paperwork like medical bills submitted – the claim is shut down. However, if an employee is hurt and no claim is opened and an employee says they were hurt 5 years before, that employee can still go after workers’ comp from an employer even if they don’t work for the company any longer. Five years later evidence is slim to non-existent. Witnesses may not recall and no reports were taken, so no one can dispute their claim.
Some employers don’t report what they think are insignificant claims for fear it will affect their insurance rates, but high dollar claims cause more damage to your MODs (premium modification factors) than small claims. It’s always best to report. 
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