The Workers Compensation Process

When an individual is injured while on the job at a company that offers workers compensation, there is a specific process that must be followed in order for the claim to be considered valid and result in payments to cover the injuries and time spent away from work.

Prior to making any claim to the insurance program, the injured worker or his or her representative must inform the company or employer that an injury has actually occurred. While doing this, it is important to provide medical information to the employer so that everyone knows what the injuries were and what is expected for recovery.

To gain workers compensation, the injured worked does not, generally speaking, have to send a written claim form to the insurer in order to receive workers compensation. Instead of a written claim, once the insurer is informed of the injury by the employer, the worker, or a third party representative, the insurance company will offer provisional liability payments. These payments start within seven days, in most cases. During this time, the insurer will investigate the facts of the injury and the extent of the injury and make a decision either to continue the payments or to stop further payments.

After being informed of the injury, the insurance company, before provisional liability payments begin or a claim is even accepted, the insurer will need certain facts. The company will investigate the matter by questioning both the employer and the worker. In addition, information from the treating doctor will be sought.

Within seven days of being informed verbally, electronically, by form, or by any other method that an injury has occurred, the insurer must start provisional liability payments to the injured worker. In some rare cases, there may be a valid, reasonable excuse not to start payments within this period. The insurer must also decide how long it is going to make provisional liability payments. These payments can carry on for a maximum of twelve weeks.

In the event that a claim form is submitted following the initial notification of the injury and the start of provisional liability payments, the insurer then has twenty-one days or until the end of the provisional liability period to make a decision. The insurer, in this instance, can decide to extend the provisional liability period for another four weeks, based on the type of injury and the level of incapacity.