Charles Spinelli Offers an Outline of Workers’ Compensation Claim Process

Most employers are legally obligated to carry workers’ compensation insurance to cover employees who get injured or sick caused by their occupation. Workers’ compensation is formulated and enacted all over the US to offer benefits to workers. The compensation involves paying medical expenses, particle wage replacement, and so on. According to Charles Spinelli, workers’ comp. insurance works as a safety net both for employees and employers. While it takes care of injured workers by offering them much-needed benefits, it also saves the employer from paying for costly medical expenses as well as avoiding penalties by the authority for violating the law. 

Advantageously, the insurance program is a “no-fault system.” However, to secure benefits of workers’ comp. an injured or sick worker needs to prove or establish that the mishap happened on the job. The rules and specifics of the law vary between states. Regardless of the state law, the process of a workers’ compensation claim should follow the steps below:

Get Medical Attention Right Away

Before filing a claim under workers’ comp, workers are instructed to get the required medical intervention. It is the best choice to inform about the injury to the supervisor by writing and accordingly visiting a specified doctor under the insurer’s network. Keep in mind that a medical report will work as evidence as well as an official record of the injury on work and it is the basis of securing workers’ comp reimbursement.

Notify Your Employer

The injured or sick worker needs to notify the employer about the mishap and that must be notified with the deadline, for instance in California and NY the statuary deadline is 30 days from the date of injury. Spinelli says that it makes sense to report the injury immediately once it occurs.

As stated above, injured workers should notify their supervisors in writing, even if a verbal notification is given in the first place. Again, note carefully that a written notification will work as an official record which is needed for availing compensation.

In general rule, the employer will provide an official claim form which is a part of the workers’ compensation claim process. If any worker does not get the required form, make sure to contact the workers’ compensation board of the particular state or talk to a lawyer immediately. The information, that a worker needs to provide in the form includes:

  • Date, time, and place of injury
  • Type of injury; the injured or affected part of the body
  • How the accident took place
  • Parties/workers involved in the accident
  • The medical treatment the injured worker has received

Also known as the ‘first report of injury’, this report needs to be submitted as soon as possible after the injury, as per Charles Spinelli.

Employer’s Responsibility in Workers’ Comp Claim Process

Now, it is the responsibility of the employer to furnish a claim with the relevant insurance carrier and equally the state’s worker’s comp. board. The insurer assigns an adjuster to take care of the claim. It’s the adjuster’s responsibility to verify if the claim is valid. If required, the insurer can depute a team for investigation of the injury. Accordingly, once after evaluation of the claim, the insurer notifies the injured worker whether or not the claim is accepted apart from the benefits that the worker is entitled to.

This is the typical process of the workers’ comp claim. However, depending on the situation and state rules, the procedure may vary. Workers are highly recommended to be well aware of the claim process from the employer. If needed, they should consult a lawyer specialized in worker’s compensation as per necessity for legal assistance.