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WORKERS' COMP

Workers’ Comp Claims: Employer Questions Answered

2-minute read

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Ed Grasso

Ed Grasso

6 May 2024

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Hiring new employees is often a sign that your business is growing. As a result, it’s also a sign that you might need to think about workers’ compensation insurance. That often can come with many questions, especially regarding workers’ compensation claims.

We‘ve got answers to some common ones here.

What Happens When an Employee Files a Workers’ Comp Claim?

Typically, the process works like this:

Step 1: The incident is reported to the employer.

If one of your employees suffers an incident, they should notify you of the situation as soon as possible, since you’ll need to document the incident’s date, time, and circumstances.

Step 2: The employee seeks treatment.

Your employee should promptly seek medical treatment for their injuries or illness. The employee's healthcare provider completes a medical report, which is sent directly to the insurance company.

Step 3: A workers’ comp claim is filed.

In most cases, you'll be responsible for filing the employee's workers’ compensation claim with your insurance company. Remember, the claim gets filed against your policy, not you or your company.

Step 4: The insurance company makes a determination.

Your insurance carrier will decide whether the employee's claim is covered, based on the information provided.

If the insurer denies the claim, your employee has the right to appeal the decision.

While the claims process isn't complicated, it could become messy if you skip one of these steps. To ensure that your employees know how workers’ comp insurance works, it's always wise to provide them with workers’ comp training.

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Can an Employer Ask About Workers’ Compensation Claims?

As an employer, you certainly want to protect a new hire from getting hurt, as well as limit any potential workers’ comp claims, so this may seem like a reasonable question.

Whether you can ask about previous claims often depends on when the question is asked. According to the Americans with Disabilities Act (ADA), you can’t ask a potential employee about previous workers’ comp claims before making a job offer.

If a candidate accepts your offer, you can ask certain questions about previous claims. It’s important to know that these questions must be consistently asked of all potential employees.

Can an Employer Dispute a Workers' Compensation Claim?

Since claims can affect an employer's workers’ comp costs, an employer may challenge a claim if they suspect that it’s fraudulent, exaggerated, or that it was not job-related. Workers’ compensation laws often differ from state to state, but most states do allow an employer to dispute a workers’ comp claim.

Typically, an adjuster handling the claim will interview an employer. That’s when an employer can raise issues about the validity of the claim. It can be helpful to have records such as incident reports, witness statements, and other documentation available to share with an adjuster.

Can Casual Employees Claim Workers’ Compensation?

A “casual employee” is one who generally doesn’t have a set work schedule or who doesn’t work a set number of hours. In most states, casual workers are not covered by workers’ compensation insurance.

However, laws can vary by state, so we recommend checking the rules in the locales where you run your business.

What is a Non-Compensable Workers' Compensation Claim?

This is a claim that is generally denied because it is not covered under a particular workers’ compensation policy. It can be related to the type of injury or the circumstances under which the injury occurred, such as:

  • Injuries that aren’t related to an employee’s normal work
  • Injuries that occurred outside work
  • Injuries that are self-inflicted
  • Injuries suffered while intentionally violating safety protocols or while committing a crime

More Questions? We Can Help

We know small business insurance can be complicated, especially workers’ comp. That’s why we have an entire section of our online Resource Center dedicated to a wide range of workers’ compensation topics. Here are three we recommend:

If you’re wondering what coverage you might need and what it might cost, we often can get you a quote in just 10 minutes online, 24/7.

And if you’d just like to speak with someone who understands workers’ comp and what it’s like to be a small business owner, we have licensed agents waiting on the phone to answer your questions. They’re here M-F, 8 a.m.-8 p.m., at 855-930-2844.

Ed Grasso

Written by

Ed Grasso

As a 9-year-old at summer camp, I hated it — especially after being pulled screaming from the pool during the swimming competition. While this left me without an aquatic achievement patch, it also inspired the letter to my parents that got me an early release from Camp Willard. That showed me the power of writing. I’ve done my best to use it only for good ever since, such as writing helpful articles for small business owners.

Ed writes on a number of topics such as liability insurance, small business funding, and employee management.

This content is for general, informational purposes only and is not intended to provide legal, tax, accounting, or financial advice. Please obtain expert advice from industry specific professionals who may better understand your business’s needs. Read our full disclaimer

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