How Does the Workers' Compensation Claim Process Work?

It's important that the illness or injury is reported and the workers' comp claim is filed as quickly as possible. Most states have a time limit for when a workers' comp injury can be reported to their manager. This time limit is usually between 30 and 90 days. Learn the step by step process to filing a workers' comp claim .

What Does Worker’s Compensation Cover?

Q: Who Is Covered by Workers' Comp?

Most states require full-time employees to be covered by workers' comp insurance . Some places have state laws for contractors, temps and interns. It's important to make sure your workers' comp coverage is up to date and correct. Some states do not require certain types of employees to be covered by workers' comp insurance. Learn about the types of employees who do not need to be covered by workers' comp .

What Does Workers’ Compensation Cover infographic

All About Workers’ Compensation Coverage

Workers’ compensation insurance, also known as workman’s comp, provides benefits to employees who get injured or sick from a work-related cause. It also includes disability benefits, missed wage replacement and death benefits.

Workers’ comp also reduces your liability for work-related injuries and illnesses. Without coverage, your employees can sue you for a work-related injury or illness to help pay for their medical costs or lost wages.

Most states require businesses with employees to carry workers’ compensation insurance. However, each state has different rules that can affect the cost of workers’ compensation insurance, so the state or states where you do business will determine your workers’ comp insurance requirements. It’s your responsibility to buy coverage through a licensed insurance company, like The Hartford.

What Does Workers’ Comp Cover?

If your employee suffers a work-related injury or illness, workers’ compensation benefits can help cover their:

Medical expenses
Lost wages
Ongoing care costs
Funeral expenses

These workers’ comp benefits aren’t available if your employee gets hurt or sick outside of work. Benefits may also not be available for intoxicated employees that get into an accident, or employees that intentionally hurt themselves.

Medical Expenses

Workers’ comp insurance provides coverage to help your employee pay for medical expenses related to a work-related injury or illness. This can include emergency room visits, necessary surgeries and prescriptions. For example, if one of your electricians cuts their hand at a customer’s home, workers’ compensation insurance can help cover their hospital visit.

Missed Wages

Workers’ comp helps replace some of your employee’s lost income if they need time off to recover from a work-related injury or illness. So, if your restaurant chef spills a pot of boiling water on her arm and can’t work for two weeks, workers’ compensation coverage can help replace some of her lost wages.

Ongoing Care

Some work-related injuries or illnesses can be so severe that they need more than one treatment. For example, if your warehouse employee hurts their back while lifting heavy boxes, workers’ comp insurance can help cover their ongoing care costs, like physical therapy.

Funeral Costs

In the unfortunate event your employee loses their life from a work-related accident, workers’ compensation coverage can help cover their funeral costs and provide death benefits to your employee’s beneficiaries.

Enfermedad

Sometimes, working conditions can expose your employees to harmful chemicals or allergens that lead to illness. If your employee gets sick due to a work-related incident or condition, workers’ comp insurance can help cover their costs for necessary treatment and ongoing care.

Repetitive Injury

Not all work-related injuries are the result of a single traumatic incident. Repetitive injuries, like carpal tunnel syndrome, can take months or years to develop. If your receptionist develops carpal tunnel syndrome after years of typing with poor ergonomics, workers’ comp can help cover treatment costs and ongoing care bills.

Incapacidad

Some work injuries may be severe enough to temporarily or permanently disable your employee. Workers’ compensation coverage can give your disabled employees benefits to help pay their medical bills and replace some of their lost wages.

Let’s say your foreman loses the use of one of his legs and is partially disabled because of a work-related accident. He’s unable to return to work and needs continued medical and financial support. Workers’ comp can help cover his treatment costs and supplement some of his missed wages through disability benefits.

Who Is Covered by Workers’ Comp Coverage?

Several factors, like specific roles and the size of your business, determine which employees need workers’ compensation coverage. Requirements vary from state to state, but most require workers’ compensation coverage for full-time employees. Some states have laws about workers’ comp for contractors, temps and interns. It’s important you know what your state requires for workers’ comp coverage.

Some states don’t require workers’ compensation coverage for:

Farmhands
Insurance agents
Family members under a certain age
Casual workers
Business owners and partners
Real estate agents

Federal government employees are also not covered by state-regulated workers’ compensation insurance. Instead, they’re covered by federal workers’ comp. These exceptions do not apply to every state, so you need to understand your state’s workers’ compensation laws.

Some states have a minimum number of employees to determine if a business needs workers’ compensation insurance. These states are:

How Does the Workers’ Compensation Coverage Claim Process Work?

Workers’ comp claim processes also vary from state to state. However, no matter where you’re located, it’s important to start the claim process as soon as possible after a work-related illness or injury occurs. Knowing the following requirements and insights can help you with this process:

Make sure your injured or ill employees get immediate medical care.
Your employee or their representative should notify you about the work-related injury or illness as soon as possible.
You’ll need to contact your workers’ comp provider to submit a claim. You may also need to notify a state-run workers’ comp board.
Your insurance company will review the claim and approve or deny benefits.
Your employee will get approved benefits and compensation.

Most states have a time limit for when your employee can report a workers’ comp injury to their manager. This is usually between 30 and 90 days.

There may also be a time limit for when an employer can report a workers’ comp injury to their insurance company. It’s important you understand how the claims process works in your state, and if there are any statutes of limitations for coverage.

How to Select the Right Workers’ Compensation Coverage for Your Business

We’re backed by over 200 years of experience in helping small business owners protect themselves from unexpected risks. At The Hartford, you’ll have access to our claims specialists, who consistently receive top scores for satisfaction.* We also offer flexible billing solutions so you can focus on running your business. Reciba una cotización today and learn more about workers’ comp coverage.

This article provides general information, and should not be construed as specific legal, HR, financial, insurance, tax or accounting advice. As with all matters of a legal or human resources nature, you should consult with your own legal counsel and human resources professionals. The Hartford shall not be liable for any direct, indirect, special, consequential, incidental, punitive or exemplary damages in connection with the use by you or anyone of the information provided herein.

What Does Workers’ Compensation Cover?