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Claims Processing for Workers’ Compensation

Whether you are an employee or an employer, it is important to file a workers’ compensation claim if someone has experienced a work-related injury or illness. Failure to do so can result in the denial of workers’ compensation insurance benefits.

Published on:
January 16, 2023

 When Should You File Workers’ Compensation?

Workers’ compensation benefits most likely cover the injury or illness of an employee if the incident happens on the job or within the scope of employment. The claim can be filed if the employer has an active workers’ compensation policy, the employee in question is an eligible employee of the business, and the employee became injured due to working conditions. Unfortunately, workers’ compensation does not typically cover stress or other psychiatric issues, self-inflicted injuries, injury during a commute, or if the employee has violated company policies such as fighting, horseplay, working under the influence, etc.


Business owners must educate themselves on their state’s workers’ compensation laws and follow their process. Failure to do so can result in expensive fines or penalties. In addition to having an active policy, the employer must also provide their employees with accurate information related to their rights and benefits, report the injury or illness within specified deadlines, and accurately classify the injuries.


What is the Workers’ Compensation Claims Process?

Each state has specific laws that regulate workers’ compensation. Employers must do their due diligence by researching the requirements in their state. Generally speaking, the number of employees dictates when a business needs compensation insurance. The penalty for not doing so can result in a fine or jail time.


There are five steps to complete the workers’ compensation claims process:

1.   The employee should report the injury to their employer immediately and provide written documentation.

2.   The employer should navigate additional steps with the employee. In most states, the employer will provide a worker’s compensation claim form to be filled out.

3.   The employer is usually responsible for sending the claim form and all other documentation to their workers’ compensation insurance carrier, but the employee’s doctor will also file a medical report.

4.   The insurance provider will either approve or deny the claim. If the claim is approved, the employee will be contacted with payment details and, along with their lawyer, will either accept the payment offer or negotiate a larger lump-sum settlement. If the claim is denied, the employee can either request a reconsideration from the insurance provider or file a formal appeal through their state workers’ compensation board or commission.

5.   Employees can return to work when they have recovered from the injury and have provided their employer and insurance provider with a written notice. In severe cases, the insurance company may have to pay permanent disability benefits.


How Does Wisedocs Handle Medical Documents for Workers’ Compensation Claims?

Wisedocs automatically generates medical chronology to organize a company’s claims in a matter of hours. Employers can sort by date, service provider, title, and document category through Wisedocs’ innovative electronic data processing. Wisedocs processes medical records 70% faster and allows the sharing of medical records with colleagues and insurance providers at ease. If you have workers’ compensation claims or other documents that you need to organize for shareability, Wisedocs can assist!

Alanna Andersen
Content Writer

Alanna Andersen is a professional freelancer in the art of writing, editing, and proofing. In her past life, she was a Booking Agent and Tour Manager in the music industry and restaurant General Manager in bustling downtown Toronto, Canada. As an avid researcher, she enjoys learning new things and expanding her knowledge. In her spare time, she enjoys travelling around the world, spending time with her cats, dancing to live music, and watching horror films.

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