The Simple Step-by-Step Guide for the Worker’s Comp Claims Process

Managing Worker’s Compensation (WC) claims for your employees can be complex and tricky. Here is a breakdown of the claims process to assist you in understanding what to expect when an injury is reported.

Step 1

For emergency assistance, dial 911 immediately.

Provide medical attention, if necessary. Refer your employee to the nearest Medical Provider Network facility. If the employee refuses medical care, ensure the employee completes a Refusal of Medical Treatment form. We recommend completing a state-required claim form even if the employee declines medical treatment. This is a proactive approach to documenting the incident. This way, if the employee opts for medical treatment later, your documentation is already done.

Step 2

Gather the facts. 

Provide the employee with a state-required claim form and an Employee Incident form. Ensure the witness statement form and the Supervisor form are completed—as all of these will be essential in identifying the root cause of the incident—and assist in identifying and correcting hazards.

Step 3

Contact your claims team to assist you with coordinating treatment, gathering information surrounding the injury, reporting the claim, and post-submission claim monitoring.

Step 4

Mitigate your exposure by:

• Providing temporary modified duty. This will assist in keeping the cost of the claim down while minimizing the impact on your Experience Modification Rate (EMR). Additionally, the employee remains productive and in a financially stable position by keeping his/her income closer to pre-injury wages while undergoing treatment. 
  
  
• Monitoring the claim. Sometimes requests for authorizations of treatment get lost in transmission, which will impede recovery. The work status may change which will require you to adjust tasks or return the employee to full duty. Additionally, forward the work status notes to the adjuster to update the claim file if work restrictions change. The more involved you are with the evolution of the claim, the more quickly your employee will recover and the claim will close. Your Claims Advocate will walk you through every step of the way to ensure your claim is thoroughly monitored and closed promptly.
  
  
• Keeping an open line of communication with the injured worker. Employers who maintain empathetic and compassionate contact with injured workers during the treatment process have more satisfied employees, boosted morale, and prevent the employee from feeling alienated.
  
  
• Educating your employees. A workplace safety program is critical in preventing injuries and eliminating hazards wherever possible. Promptly conduct a tailgate safety meeting with all employees and share the specific hazards that were identified from the incident and introduce a safer way to do the job.
  
  

If you find yourself dealing with a claim, refer back to our Step-By-Step guide above as a reference. It’s also important to talk with your Claims Advocate as they are there to help you. Reach out to TSIB today if you have any questions or want to speak to one of our Worker’s Comp Claims Advocates! For additional information around claims, you may also visit TSIB’s claims services webpage.

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