What Happens After a Workers’ Compensation Claim Is Filed?

Steps to Take After a Work Injury Claim is Filed in San Diego, CA

Workers’ compensation ensures agencies provide payments to employees who have a work-related injury or illness preventing them from performing their duties. Because workers’ comp is a state-mandated program, the process of what happens after a claim has been filed can vary somewhat, but all states follow a general framework. The insurance experts at American Tri-Star San Diego are here to show you some of the major steps in this process.

A Doctor’s Report Is Filed

Within a few days after the employee visits a doctor for the work-related injury or illness, the doctor must file a report with the closest workers’ compensation office. Copies of the report must also be sent to the employee and employer.

The Employer Files a Report

Within a week or two—the time frame depends on the state, the employer must report the injury to the local workers’ compensation board and to the agency’s insurer. Once the insurer receives that report, it usually has two weeks to inform the worker of his or her rights and also to notify the worker of whether he or she is required to see another doctor.

Payment Is Dispersed Or the Claim Is Disputed

Within two to three weeks after receiving the employer report, the insurer must begin making any required payments or dispute the claim. Among the most common reasons claims are disputed are the injury or illness not being work-related or the employee not missing enough work to justify payments.

The Employee Is Monitored

Depending on the state, the person receiving workers’ comp payments will have to report to a doctor at regular intervals to have his or her condition reevaluated. At these visits, a doctor will determine if the employee is ready to return to work. If he or she cannot return to work after a certain amount of time, the doctor will make a recommendation on rehabilitation or whether there is a permanent disability.

Some aspects of the workers’ compensation process can be difficult to understand, but it’s important to stay informed in the event an employee is injured on the job. If you have any questions about workers’ compensation or affordable commercial insurance in San Diego, give American Tri-Star a call today at 619-272-2100. Our agents would be happy to help you find the best insurance solutions for your business.