Skip to main content

What to do when you have a Work Comp claim

By March 1, 2022June 5th, 2022Insurance
  1. Determine if the injury is life threatening. If an injury is life threatening you should be calling an ambulance – or driving that employee to the hospital that is closest to where the injury occurred.
  2. If the injury is not life threatening pick the closest Urgent Care Center and send your employee there. DO NOT SEND YOUR EMPLOYEE TO THE HOSPITAL UNLESS THE INJURY IS LIFE THREATENINIG.
    1. Hospitals are expensive and increase the amount of your claim unnecessarily in most instances.
  3. Call your Work Comp insurance agent for advice on the claim. Give them as much detail as possible. Some crucial items that your agent will need in order to properly manage your claim are as follows:
    1. Date and time of accident. If the accident was reported late – (not same day) we need to know why.
    2. Detailed description of the accident.
    3. Where there any witnesses? If so, please have them give written statements of the accident same day.
    4. Is there any suspicion of fraud? Is the claim legitimate?
    5. Does the employee have any pre existing health conditions that you are aware of?
  4. Report your insurance claim to the insurance company after speaking with your agent. Make sure you email your agent the confirmation – claim number and adjuster information when it is received.
    1. Keep this information handy as you will need it to manage the claim moving forward.
  5. If your company has a drug free workplace program (which saves you 5% on your total work comp premiums) please be sure that the employee receives a drug test the same day as the injury. Most urgent care facilities or hospitals can accommodate this.
    1. If the employee does not receive a drug test same day – it is nearly impossible to deny the claim for drug use. A lawyer cannot pinpoint when drugs were taken AFTER a claim. If the drugs are in that employee’ system same day it is much easier for you to control the outcome.
  6. Have your employee – or the supervisor that drove the injured worker – request a WORK STATUS REPORT from the treating physician.
    This will tell the employer what the injuries sustained were – it will also let you know if there are any work restrictions for your employee.
  7. Once you have a work status report send a copy to your agent so you can both come up with a plan on how to handle lost time benefits. Each claim is different. Depending on the amount of time that will be missed from work – or how serious the injuries are (if surgery is a potential) – there will be a variety of things your agent will suggest in order to control the long term costs of your work comp claim.