How to File a Workers’ Compensation Claim

Information for Employers and Employees

If you're a new business owner, you already know you're required to carry workers' compensation insurance in case one of your employees is injured on the job. Providing wage and medical benefits for workers isn't anything new; in fact, workers' comp has been in effect in the U.S. since 1906. This type of insurance is designed to provide workers a safe and healthy work environment and at the same time protect employers from frivolous lawsuits.

Workers' compensation claims are governed on the state level, so each state has a specific procedure to follow in case of an injury. On the other hand, federal employers and employees must follow Department of Labor guidelines in order to file a claim. Both employer and the injured employee have certain steps they must follow when there's an accident during work hours, and as the business owner it is your responsibility to both file the company paperwork and to provide your employee with the information they need to follow through on their end.

In addition to the workers' compensation claim there are certain instances where the Occupational and Safety Health Administration (OSHA) must by law be notified. As the business owner it is your responsibility to ensure all requirements of Workers' Compensation Laws are met within the required timeframe.

Severe injuries and deaths

If there is a serious accident that results in an amputation, loss of an eye or an in-patient hospitalization, you must report the accident to OSHA within 24 hours. If an accident results in the death of an employee, it must be reported to OSHA within eight hours. You may report the accident to OSHA online or via phone and you'll need to provide:

Your business name
The name of the employee affected
The location and time of the accident
A brief description of the accident
The name of a contact person and phone number representing your business

How to file a claim

When there's an injury on the job the first step should be for the acting supervisor to fill out a standard accident report, with the help of the injured party if they are able to contribute. This will allow you to have a hard copy outlining the details of the incident while it is fresh in memories and all witnesses are present. You'll need this report as well as your injured worker's employee file to complete the workers' compensation (comp) form.

While the workers' comp form and procedure will vary somewhat by state the information you're required to provide on behalf of your company will be the same. For example, in Washington State your forms would be found on the Washington State Department of Labor and Industries website and you'd need to give the following information:

Employee's full name, address, date of birth, and phone numbers
Employee's date of hire, employee number, position, supervisor, and location of work
Date, time, and place of injury or illness
Detailed information of injury or illness and how it occurred
Names and information of any witnesses
Whether injury required emergency or medical treatment or hospitalization and details of medical provider/s
Any medications prescribed
If and when the employee returned to work and what restrictions (if any) were given

Steps for employees

Employees who are injured while on the job also must file paperwork and again it will vary depending on the state of residence. Using Washington State as an example, and injured worker has the options of filing a claim online at the Washington State Department of Labor and Industries (L&I) website, at their doctor's office at time of treatment, or by calling the L&I during regular business hours.

An injured employee will need to fill out the Report of Industrial Injury or Occupational Disease with the same type of information provided by the employer. In addition, their medical provider will be required to submit an Activity Prescription Form that will outline the injury or injuries treated, prognosis, and any work restrictions needed.

If your business is self-insured you are required by the State of Washington to provide your injured employee with a Self Insurer Accident Report as provided by your insurance carrier.

Most states have a deadline for filing a workers' comp claim application. Washington State requires a claim be filed within one year of the injury date and within two years of diagnosis for an occupational disease.

Steps for federal employees

Federal employees must file their workers' compensation claim with the U.S. Department of Labor. The form used is titled Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation and designated CA-1; CA-2 is required for occupational disease claims. Federal employees may be able to file online using the submission of forms via the Employees' Compensation Operations and Management Portal (ECOMP) depending on where they work. You can also upload supporting documents tot eh ECOMP portal.

While the information required by an injured federal employee is for the most part the same they may qualify for other benefits besides medical and lost wages. Here are some of the options a federal employee might claim:

Continuation of Pay while recuperating
Compensation for leave taken due to injury
Schedule Award for loss of specific body parts or organs

According to the Federal Employees' Compensation Act (FECA) you must file a claim within three years of the date of injury. For a latent condition the three-year limit begins at the time the employee becomes aware of the condition.

Can an employee work while on work comp?

Workers' compensation insurance covers both medical and wages so the answer is a qualified yes. An injured employee's doctor may return them to work with limitations and restrictions or may state they are unable to return to work. For example:

1

Your employee may have injured her back and cannot lift but can work in a sitting position. As her employer you are not allowed to require her to lift; if you state she must be able to lift to return to work the wage benefit will go into effect.
2

Your employee is on pain medication and his doctor requires him to stay on bed rest for 10 days. He may not work during that period of time and must have a doctor's release to return to work.
3

Your employee cut her hand at work and was treated in the emergency room. The doctor gave her no work restrictions, so she can immediately return to her regular job.

In all three cases your workers' comp insurance covers the medical costs incurred by the on the job accident. In the second example comp also covers lost wages while your employee is unable to perform any job functions during the recuperation period.

Because workers' comp laws are exact you should never allow an employee to return to work until you have written notification from their medical provider that states they are physically able to do so.

Penalties and precautions

It is vital that as an employer you do not show discrimination in any way to an employee who has filed a workers' compensation case due to an on-the-job injury. Examples of discrimination are:

If an employee feels they are being discriminated against in retaliation for filing a workers' comp case they may have a legal claim to sue you, their employer. In that case you would be required to prove to a jury or judge that no discrimination took place. The employee would have to show they were discriminated against or wrongfully terminated but would not have to show the workers' comp case was the sole reason.

By the same token, as an employer you may do any of the above if the worker has not followed company policies, fails to follow health and safety rules, and has several on-the-job injuries. If as an employer, you feel your worker is purposely not following the policies and rules as set by the company you should begin a paper trail so that each violation is recorded in a proper manner. You cannot retaliate in any way against a worker who has been injured at your company but at the same time must be aware of individuals who might try to take advantage of the workers' compensation laws.

Facts to know

Failure to carry workers' compensation insurance can lead to fines, criminal charges, and expensive litigation.
In most states employers are required to post a notice outlining workers' comp laws in an area where all employees have access to the information.
Your state's department of labor will have many resources regarding workers' compensation laws as well as safety practices.
Employers must provide emergency treatment when workers are injured on the job.
You must also provide medical treatment for non-emergency accidents that occur during work hours.
An employee who is involved in a vehicle accident while performing work duties (such as deliveries) is covered by your workers' comp insurance. An employee who has an accident on the way to or from work is not.
Employers must complete an injury report and file it with the workers' comp office.
Injured employees may return to work in a restricted role with their doctor's written permission detailing what they cannot do.
Employers must comply with all information requests in regard to workers' comp insurance claims before, during, and after the time the claim is filed.
Employers must report the date the worker returns to their job and all other status changes as they occur.
Workers' comp doesn't just cover accidents; long-term injuries such as carpal tunnel is covered as well as occupational diseases such as black lung.
In most states employer workers' comp payments go into a state fund that covers claims.
The type of business and injury statistics related to that classification determines the cost of your workers’ comp policy.
In some cases, employees can still sue their employer even though their injury was covered by workers' comp.
If an employee is permanently disabled, they may continue to receive benefits.
Workers' comp provides medical care and lost wages as well as rehabilitation services for injured workers and death benefits for dependents when a worker is killed on the job.
Workers' compensation cases are considered "no-fault”, so the amount of money received does not go up or down due to negligence on either employer or employee's part.
While a few industries are exempt, most companies require workers’ comp.