How insurance companies handle workers’ compensation claims

Last Updat­ed on April 18, 2023 

Work­ers’ com­pen­sa­tion is a type of insur­ance that pro­vides wage replace­ment and med­ical ben­e­fits to employ­ees who are injured on the job or become ill as a result of their employ­ment. It also pro­vides death ben­e­fits to the fam­i­lies of work­ers who are killed on the job.

Insur­ance com­pa­nies han­dle work­ers’ com­pen­sa­tion claims by first deter­min­ing whether the injury or ill­ness is work-relat­ed. If it is, the insur­ance com­pa­ny will then pay for the employ­ee’s med­ical expens­es and lost wages. The insur­ance com­pa­ny may also pro­vide voca­tion­al reha­bil­i­ta­tion ser­vices to help the employ­ee return to work.

If the insur­ance com­pa­ny denies a work­ers’ com­pen­sa­tion claim, the employ­ee may appeal the deci­sion. The appeal will be heard by a work­ers’ com­pen­sa­tion judge. The judge will decide whether the injury or ill­ness is work-relat­ed and whether the employ­ee is enti­tled to benefits.

Here are the steps involved in han­dling a work­ers’ com­pen­sa­tion claim:

1. The employ­ee reports the injury or ill­ness to their employer.
2. The employ­er files a work­ers’ com­pen­sa­tion claim with the insur­ance company.
3. The insur­ance com­pa­ny inves­ti­gates the claim.
4. The insur­ance com­pa­ny decides whether to approve or deny the claim.
5. If the claim is approved, the insur­ance com­pa­ny pays for the employ­ee’s med­ical expens­es and lost wages.
6. If the claim is denied, the employ­ee may appeal the decision.

The fol­low­ing are some of the rea­sons why an insur­ance com­pa­ny might deny a work­ers’ com­pen­sa­tion claim:

• The injury or ill­ness is not work-related.
• The employ­ee did not report the injury or ill­ness in a time­ly manner.
• The employ­ee’s injuries are not severe enough to war­rant work­ers’ com­pen­sa­tion benefits.
• The employ­ee is not eli­gi­ble for work­ers’ com­pen­sa­tion ben­e­fits because they were not an employ­ee at the time of the injury.

If you have been injured on the job, it is impor­tant to file a work­ers’ com­pen­sa­tion claim as soon as pos­si­ble. You should also con­tact an expe­ri­enced work­ers’ com­pen­sa­tion attor­ney to help you with your claim. An attor­ney can help you under­stand your rights and make sure that you receive the ben­e­fits that you are enti­tled to.