How to Set Up a Worker’s Compensation Claims Process at Your Small Business

Author: Christina Galoozis Date: May 03, 2011

Workers' CompensationNearly all states require employers to carry worker’s compensation insurance. But you’re a small business owner—not an insurance expert. How do you go about filing a claim if one of your workers is injured? Here are the steps to take, according to Scott Doellinger, NFIB’s former director of national workers’ compensation programs, and Gary Raia, risk management specialist with Odell Studner, a worker’s compensation insurance provider in Wagner, Pa.

Get on the same page as your insurance carrier

First, call your insurance carrier and become familiar with their process. Does the carrier expect you to report an injury within a certain timeframe after the injury occurs? Does the carrier prefer to receive a phone call or a fax when filing a claim? What type of information will the carrier need for each claim? You need to completely familiarize yourself with the insurance company’s process and requirements before designing your own in-house claims process, says Raia. Also, you should ask your carrier how prescriptions can be filled with no out-of-pocket expenses for your employees, says Doellinger.

Step 1

When seeking medical attention. If the injury is an emergency, call an ambulance and get medical attention for the employee immediately. If the injury is not life-threatening, try to get the employee to see a doctor within your worker’s compensation insurance company’s network. This makes the payment process much smoother for the business—and for the employee. Raia says it is imperative to know your state’s laws governing worker’s compensation before taking this step: In New Jersey, the employer has the right to choose which doctor an employee will see. In other states, however, that is not the case.

Step 2

While at the doctor’s office. If the injury is work-related, employees should not use their personal medical insurance for treatment. Instruct employees to tell medical personnel their injury was sustained on the job. The medical office will then ask for the worker’s compensation carrier (or employer’s name if they’re unsure). For more on preparing employees, see Step No. 5.

Step 3

Make sure the injured employee is accompanied, preferably by a manager or supervisor, says Raia. This will help your business make sure the process is handled properly. If your insurance policy requires a drug test the day of the injury, for example, a supervisor can be there to make sure that happens. (This is also why it’s imperative for managers and supervisors to be well-versed with your business’ worker’s compensation policies.)

Step 4

It is your responsibility as the employer to file a claim with the insurance company, though it’s OK to appoint someone internally to do this. (Like a human resources director.) It is not the employee’s responsibility. Insurance companies strongly urge employers to report any injuries as soon as possible, at least within the first 24 hours, says Raia. 

Step 5

Make sure your employees know what to do if they get hurt. Describe the process during employee orientation and post information sheets or posters about this process—along with the insurance carrier’s name and policy number—where employees can see it, like a bulletin board or in the kitchen. If your business operates in an injury-prone industry—construction or manufacturing, for example—consider creating your own “worker’s compensation insurance cards” that list the approved doctors, the carrier’s name and policy number.

Other ideas from Doellinger: Post the policy and procedures on your company’s internal website. Send out an email routinely reinforcing the reporting policy. And provide a customized sticker with contact information in all company vehicles, on the dashboard or in the glove compartment.

Also, don’t forget to check out NFIB’s member benefits where you can take control of your worker's compensation costs.

Read Next: Worker’s Compensation Insurance FAQs

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