Claim Company

A Guide to Workers Compensation and Involvement of a Claim Company

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Workers compensation or workers comp insurance is created to cover injuries resulting from workplace negligence. It covers a wide range of injuries and circumstances with certain limitations. The following guide elaborates who and what is covered and what are the exemptions. Because of the legal nature of related law, it is recommended to seek the help of a claim company.


Who is Covered?

Most types of employees are covered under workers’ comp insurance. But some types of workers are usually not included. These can be:

  • Volunteers
  • Business owners
  • Independent contractors
  • Farmhands/farmers
  • Private home employees
  • Railroad employees
  • Maritime employees
  • Casual workers

Expenses Covered

The workers’ comp insurance will cover a variety of expenses including the following:

  • Medical care arising out of illness or injury
  • Cost of retraining
  • Replacement income
  • Benefits to dependents of the worker who was killed on duty
  • Compensation against permanent injury

A claim company can help provide proper guidance in case of a dispute arising out of the type of injuries or illnesses covered.

Workers’ comp insurance also covers long-term and permanent injuries. The insurance cover isn’t just limited to accidents, it also covers long-term illnesses and consequences arising out of work related activities. For example, you can make a claim for back-related problems or carpal tunnel syndrome due to repetitive tasks related to your work.

Filing a Claim

You will be entitled to workers’ comp benefits if you get injured on duty or become ill because of job-related functions. When it comes to making a claim, the employee, employer and the insurance carrier have different roles to play.

As an employee, you should take the following steps:

  • Inform your supervisor or manager immediately about your injury. This must be reported even if the injury is minor.
  • Get essential medical attention without any delays.
  • Maintain all the medical documents for reference purpose or presentation in the future.

The employer will be responsible for reporting your injury or illness to the insurance carrier or the claim company. Once the official information is received, the insurance carrier will have to report your situation to your local Workers’ Comp Division.

The insurance company will then be required to pay for all the essential medical expenses. If you are required to stay off work for more than 3 days, the carrier will also have to pay you for the wages lost during the period.

Many times the insurance company may raise objections. In such a case, you may have to seek the help of a claim company.

Exemptions to Workers’ Comp

Sometimes the employee may be subjected to drug or alcohol testing and the workers’ comp benefits can be denied if it is proven that he/she was under the influence when the injury occurred. There are many other reasons why these benefits may be denied:

  • The worker was in violation of the company policy or law.
  • The injuries caused were self inflicted.
  • The employee was not on duty during the time of the injury.

Depending upon the kind of objection raised, the employee may follow the legal path and this could require either party seeking the services of a claim company.

Employers Resource helps every business at all stages with growth and development. Find out more! Call us today at (800) 559-2350.

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