Understanding Workers' Comp
Insurance Neighbor • August 8, 2019
How Does An Employee File For Workers’ Comp Benefits?
- Notify you: As soon as possible, the employee should notify you that an accident or illness has occurred. Then provide the following information: date and time the accident occurred; how it happened; and the type of injury sustained.
- Complete and submit official paperwork: You will provide the necessary forms for the employee to complete to officially apply for workers’ compensation benefits. Once they have returned the completed paperwork, you will send it to the insurance company for processing. The insurer will then either approve or deny the claim.
- Notice of status: The employee will either be presented with an offer for payment of medical and disability costs or receive a notice of denial. If the claim is denied, the employee can choose to appeal or ask the insurer to review the decision.
Why Would Workers’ Comp Fail To Pay Medical Bills?
- The case is being denied for any of a number of possible issues (for example, the incident that caused the injury fails to meet the definition of an accident; or the employee failed to provide the proper notice).
- You believe that the condition for which the employee is being treated is preexisting and not the result of a work-related accident or injury.
- You believe that the employee has reached maximum medical improvement and no additional medical care is reasonably needed.
- You believe the employee has been noncompliant or abandoned medical treatment.
What Happens If Workers’ Comp Is Not Covering Medical Bills?
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