Insured Solutions
Insured Solutions

From injury to claim: A step-by-step guide to workers’ comp.

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.

Step 5.

The claim is assigned a number by the carrier and the clock starts ticking. 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 not one can dispute their claim.