A Step-by-Step Guide to Filing a Workmen Compensation Claim

An employee involved in construction work may suffer from a bodily injury. Moreover, construction sites are prone to risks. Therefore, the employer must provide a workmen compensation policy to the employees. However, in this article, we will tell you the step-by-step procedure to file a claim under workmen compensation insurance.

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Guide to File Claim under Workmen Compensation Insurance

The employer and workmen must learn about the guide to file claims under workmen compensation insurance. In addition, the employer must provide training to the employees with regard to the reporting of such incidence which is expected to be reimbursed under workmen compensation insurance.

Let us discuss the five key steps that guide to file claims under workmen compensation insurance.

  1. Reporting of Injury

    The employees must report the injuries they have sustained to the employer. They should inform them about the incident as soon as they can report it. Generally, the employee is required to inform them about the injury in writing to the employer.

    It should be accomplished within 30 days of injury sustained by the worker. In addition, the injury must be qualified to claim under WC policy.

    Some injuries or accidents require immediate treatment. Therefore, the employee must report such incidents immediately upon sustaining the injury.

  2. Necessary Paperwork

    The employer must guide the injured worker about essential paperwork. He is required to inform him about his rights under workmen comp insurance. In addition, the employer may also provide the claim form which is expected to be filled out by the employees. The form is required to be filled in order to give a detailed idea to the insurer about the injuries sustained by a worker.

  3. Filing of Claim Form

    Upon receiving the filled claim form from the worker, the employee must report the injury to the insurer and file the claim. Nevertheless, the worker's doctor may also submit a medical report to the insurer.

  4. Approval or Denial of Claim

    Once the claim is filed by the employer, the insurance company shall either accept or deny the claim. However, the insurer must provide a valid reason for the denial of the claim.

    Let us discuss the scenario upon approval or denial of the claim.

    If the insurance company approves the claim, the insurer shall notify the employer or the person who filed the workmen's compensation claim. In addition, the insurer shall contact the employee who has sustained the injury. The employee shall be intimated about the payment he is entitled to receive from the insurance company.

    It is at the discretion of the employee to accept or reject the compensation payable by the insurance company. For example, if the worker is not satisfied with the payable claim, he may contact a lawyer to argue the case in order to receive a valid claim.

    If the insurance company rejects the claim, the employee may request the company to reconsider the claim and reach an appropriate decision. In addition, the employee may also appeal to the Workmen's Compensation Commission or Board upon denial of the claim.

  5. Return to Work

    The worker is required to notify the employer and insurance company about his recovery from the injury. The insurance company might be liable to provide permanent or partial disability benefits on the basis of the severity of the injury.

Non Coverage

The employer and employee must note that every injury is not subject to be covered under the workmen's compensation policy. The guide to file claim under workmen compensation insurance clarify only physical claim to be covered under the policy. The following injuries are not subject to be covered under the guide to file claim under workmen compensation insurance.

  • Mental stress
  • Self-inflicted damages or injuries
  • Injuries sustained due to fighting or under the influence of alcohol

Conclusion

The employer must provide guidance to the worker about their rights and benefits under WP policy. In addition, the company must report the injuries the employees have sustained and ensure appropriate coverage on the basis of severity.

Written By: PolicyBazaar - Updated: 12 April 2023
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