Workers Compensation Insurance Filing a Claim

Posted by dawson12 on December 19th, 2014

The process of filing a claim for workers compensation protection may appear simple. But, it is one among the most complicated when compared to the others of the kind. There are two main factors involved here; notifying the employer and submitting the claim in the prescribed format. Acting fast is a must here; most of the States have stringent deadlines in this respect.

How to file a workers compensation insurance claim?

As mentioned above, the process of filing a claim in workers compensation begins with the employee giving notice to the employer. The person entrusted with the task reports the same to the Workers Board in the State. The insurance provider too is being notified of the claim. The response starts with the insurance carrier paying the employee’s medical bill. The person also gets some sort of an income replacement based on the salary he/she had been receiving before the injury.

The process may slightly differ at times. It may happen that when a person consults a doctor, the physician may find that the injury is work-related. The expert may ask the concerned person to complete a form and submit it to the agency responsible for allocating compensation. In such an instance, it is highly recommended that you discuss the situation with your employer.

Exceptions

Know that if you wish to get benefit from your workers compensation coverage, you should notify your employer within thirty days after the injury is discovered. The restriction becomes lenient only if you are able to prove that failure was due to unavoidable circumstances. You are allowed to file a claim even without notifying the employer in the specified time period in the following scenarios.

  • If the failure was due to mental or physical incapability
  • If the employer was aware of the injury
  • If you are able to prove that you were prevented from making a claim.

The insurance carrier is required to inform the Board if the compensation is stopped for any reason. If the employee is being treated, the physician should submit a report on the progress made at regular intervals.

Filing a claim for death benefits

If a person happens to die while performing his/her job-related responsibilities, the next of kin can claim workers compensation protection. The C62 form along with the required documents should be submitted to the certified agency entrusted with the task in your State. The last doctor who treated the person in question also should submit the C64 form. The C65 would be taken care of by the funeral home which conducted the last rites of the deceased.

Here too, immediate action is highly recommended. The deadlines in most of the States in the US are quite stringent in this regard.

It may also happen that your employer’s insurance provider may refuse to give you the compensation. In such a situation, you can appeal to the certified authority in your State.

Filing a workers compensation insurance claim may appear complicated. But, why sacrifice your own rights due to lack of patience or reluctance to work for it?

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dawson12
Joined: September 30th, 2014
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