Is this a life-threatening emergency? Stop — call 911 immediately for any injury involving severe bleeding, loss of consciousness, difficulty breathing, or suspected spinal injury.

Workers Compensation Claims Process

Get The insured worker medical care.

Your first and most important obligation is the health and safety of the employee.

For any non-emergency injury, direct the employee to an approved or network medical provider if your state or policy requires it. Check your policy documents or call your carrier.
Keep a list of approved clinics or urgent care centers posted in your workplace before an injury ever occurs.
Many carriers offer a 24/7 nurse triage line— call it first for non-emergency injuries to get guidance on the appropriate level of care. See the carrier list below for numbers.
Do not delay treatment. Late or denied care can complicate the claim and the employee's recovery.

Report the injury to the carrier immedietly

Once the employee has received or been directed toward care, report the claim. Do not wait — most states have strict reporting deadlines, and late reporting can result in fines or claim complications.

What to have ready: Employee name & contact info, date/time/location of injury, description of what happened, medical provider visited, witnesses (if any), and your policy number.

Carrier Claims Contacts

Complete a workplace incident investigation

Immediately after ensuring care and reporting the claim, document the incident thoroughly. This protects you legally and helps prevent future injuries.

Take photos of the scene before anything is moved or cleaned up.
Collect written statements from any witnesses while details are fresh.
Complete your company's internal incident report form.
Preserve any equipment, tools, or materials involved — do not repair or discard them yet.
Identify the root cause and document corrective actions taken.

Actively manage the claim and support recovery

Your involvement doesn't end once the claim is filed. Active claim management leads to better outcomes for the employee and lower costs for your business.

Stay in regular, supportive contact with the injured worker.
Work with your carrier to develop areturn-to-work plan— even light-duty work helps recovery and reduces costs.
Follow up on all medical appointments and treatment updates provided by the carrier.
Complete any post-incident drug screening required by your policy promptly.
Watch for signs of potential fraud — report any concerns to your carrier's Special Investigations Unit.

Workers' Comp FAQ for Employers

Reporting a Claim

When do I need to report a workplace injury?

You should report the injury to your insurance carrier as soon as possible — ideally the same day or the next business day. Most states have a legal deadline (often 10 to 30 days) for filing a First Report of Injury, but waiting that long is not advisable.

Late reporting can result in state fines, claim complications, and difficulty investigating the incident while details are fresh.

Report first, after reporting you can gather information, facts and details to supplement the original claim.

What information is needed to file a workmens compensation claim?

Most carriers will ask for the following at the time of reporting:

Employee's full name, address, date of birth, and job title
Date, time, and location of the injury
A description of what happened and how the injury occurred
Body part(s) injured and nature of the injury
Name and address of the treating medical provider
Names of any witnesses
Your policy number and employer information

You may not have all of this at the time of the first call — report what you know and follow up with the rest.

Do I need to report minor injuries that don't require a doctor visit?

It depends on your state and carrier. Many carriers ask that you report all injuries, even minor ones, so there is a record if symptoms worsen later. Some employers use an internal incident log for very minor first-aid-only injuries and only file a formal claim if treatment is needed.

Check your policy and your state's reporting requirements. When in doubt, report — an unreported injury that becomes serious later is far more problematic than a report that turns out to be minor.

What happens after I report the claim?

After you file, the carrier will assign a claims adjuster who will be your primary contact throughout the claim. The adjuster will:

Confirm the injury is covered under your policy
Contact the injured employee to explain their benefits
Coordinate medical care and any referrals
Investigate the circumstances of the incident
Determine and manage wage replacement payments if applicable

You should receive contact information for your adjuster within 1–3 business days of filing. Keep that information handy — they are your go-to throughout the process.

Medical Care

Can I choose which doctor treats my injured employee?

This varies significantly by state. In many states, employers or carriers have the right to direct injured employees to a designated medical provider, panel of physicians, or occupational health clinic — at least for the initial treatment. In other states, the employee has the right to choose their own physician from the start.

Know your state's rules before an injury occurs and have an approved clinic identified. Your claims adjuster can also help guide you on this at the time of the injury.

What if the employee goes to the emergency room for a non0emergency injury?

Workers' comp will typically cover necessary emergency room treatment. However, if a non-emergency injury is taken to the ER when an urgent care clinic would have been appropriate, your carrier may contest excess charges.

The best way to prevent this is to have supervisors call your carrier's nurse triage line first for any injury that is not a clear emergency. The nurse can help determine the appropriate level of care and direct the employee to the right facility.

Who pays for the medical treatment?

Your workers' compensation insurance carrier pays for all reasonable and necessary medical treatment related to the work injury — there is no deductible or co-pay charged to the employee for covered care. This includes doctor visits, prescriptions, physical therapy, surgery, and other treatment directly related to the injury.

The medical provider bills the carrier directly. The employee should not have to pay out of pocket for covered treatment. If they receive a bill, contact your adjuster immediately.

Benefits and Pay

Does the employee get paid while they're out of work?

Yes, if the employee is unable to work due to a covered injury, workers' comp will pay temporary disability (often called "lost wage" or "indemnity") benefits. The amount is typically two-thirds (about 66.67%) of the employee's average weekly wage, up to a state-set maximum.

There is usually a waiting period — commonly 3 to 7 days — before wage benefits begin. If the employee is out for an extended period (varies by state, often 14 days or more), benefits are typically paid back to day one retroactively.

Do I have to continue paying the employee's salary while ther're on workers' comp?

No — the workers' comp carrier pays wage replacement benefits directly. You are not required to continue paying full salary on top of those benefits. However, some employers choose to supplement the difference as a matter of policy or as part of a collective bargaining agreement.

Be careful not to pay both full salary and allow the employee to also collect indemnity benefits without a formal arrangement — this can create legal complications. Ask your adjuster how to handle this properly.

Can I use the employee's sick leave or PTO for workers' comp absense?

In many states, you can allow or require the employee to use accrued paid leave during the workers' comp waiting period (the days before indemnity benefits kick in). Some states restrict this. Once indemnity benefits begin, using PTO to supplement workers' comp pay can be structured, but it should be done carefully and in coordination with your adjuster to avoid overpayment issues.

Note: Workers' comp rules vary widely by state. Always confirm with your adjuster before directing the employee on how to use their paid leave during a claim.

Return to work

What is a return-to-work program and do I need one?

A return-to-work (RTW) program is a structured plan to bring an injured employee back to the workplace — even in a modified or light-duty capacity — before they are fully recovered. Employees return to meaningful work with restrictions that accommodate their medical limitations.

You are not required by law to have a formal RTW program, but the benefits are compelling:

Employees who return to work sooner tend to recover faster
Indemnity (wage replacement) payments stop or reduce when the employee returns
Your claim costs — and ultimately your premiums — are lower
It reduces the risk of permanent disability determinations

The doctor released the employee with restrictions. Do I have to accomodate them?

In most cases, yes — if you have meaningful modified-duty work available within the employee's medical restrictions, you are generally expected to offer it. Refusing to bring back an employee who can work within restrictions may result in continued indemnity benefit payments and can create legal exposure.

If no modified duty exists at your location, talk to your adjuster. Some carriers can help with transitional duty placement or have resources to assist.

Important: Do not bring an employee back to a job that exceeds their restrictions. Re-injury on the same claim can significantly increase your costs.

What if the employee refuses light-duty work?

If you offer modified duty that is within the employee's restrictions and they refuse without good cause, their indemnity (wage replacement) benefits may be suspended or reduced in most states. The offer must be genuine, documented, and within the medical restrictions set by the treating physician.

Document the offer in writing (date, job title, hours, pay rate, duties, restrictions it accommodates) and notify your adjuster immediately if the employee refuses. They will advise you on next steps.

Cost & Premium

Will the claim raise my workers' comp premium?

It depends on the size and cost of the claim, and on your business size. Workers' comp premiums are influenced by your Experience Modification Rate (EMR or "X-Mod"), which is a factor calculated from your claims history compared to other businesses in your industry.

Claims that result in paid indemnity (lost wage) benefits and/or significant medical costs have the greatest impact on your EMR. Small medical-only claims have a much smaller effect. Large single claims can impact your EMR for up to three years.

The best strategy: Fast reporting, good medical management, and an active return-to-work program all minimize the total claim cost — and therefore your long-term premium impact.

What is an Experience Modification Rate (ERM)?

Your EMR (also called an X-Mod or experience mod) is a multiplier applied to your base workers' comp premium. It compares your actual claims history to the expected claims history for a business of your size and type.

An EMR of 1.0 means you're average for your industry
An EMR below 1.0 (e.g., 0.85) means fewer/smaller claims — you get a premium discount
An EMR above 1.0 (e.g., 1.25) means more/larger claims — you pay a premium surcharge

Your EMR is typically calculated annually and reflects three to four years of claims history, excluding the most recent policy year.

Should I pay a small claim out of pocket instead of filing?

This is commonly called "going bare" on a claim, and it carries significant risk. While it may seem like a way to protect your EMR, consider the downsides:

A minor injury can worsen unexpectedly, and without a filed claim the employee may dispute coverage
You may still be legally required to file a report with your state workers' comp board regardless of whether you file with your carrier
If discovered, it can jeopardize your coverage and your relationship with the carrier
You lose the carrier's support, medical management resources, and legal defense

Talk to us before making this decision — we can help you understand the real EMR impact of a specific claim versus the risk of not filing.

Legal Compliance

Can I fire an employee because they filed a workers' comp claim?

No. Terminating or retaliating against an employee for filing a workers' compensation claim is illegal in every U.S. state. This is known as workers' comp retaliation, and employees who experience it can sue the employer for damages — separate from and in addition to their workers' comp claim.

You may discipline or terminate an employee for unrelated performance or conduct reasons while a claim is open, but the timing can create legal risk. Document everything carefully and consult an employment attorney before taking any adverse employment action against an employee with an open claim.

What if I think the claim is fraudulent?

Report your concerns to your claims adjuster immediately. Do not confront the employee directly or conduct your own investigation in a way that could be perceived as harassment or intimidation.

Your carrier has a Special Investigations Unit (SIU) equipped to investigate suspected fraud. Provide the adjuster with any documented evidence you have — witness statements, surveillance footage, inconsistencies in the reported incident, prior knowledge of the employee's activities, etc.

Important: Do not deny or delay legitimate medical care while fraud is being investigated. If the claim is later found to be fraudulent, the carrier will pursue recovery. Denying care prematurely can create legal liability for you.

Does OSHA require me to report workplace injuries?

Yes, many employers are required to report certain serious injuries to OSHA in addition to filing a workers' comp claim with their carrier. OSHA requirements include:

Report any work-related fatality within 8 hours
Report any in-patient hospitalization, amputation, or loss of an eye within 24 hours
Maintain an OSHA 300 injury and illness log if you have 10 or more employees and are not in a partially exempt industry

These are federal requirements — your state may have additional obligations. Workers' comp reporting to your carrier and OSHA reporting are separate obligations; one does not substitute for the other.

Can a contractor or subcontractor file a workers' compensation claim against me?

Possibly — this is one of the more complex areas in workers' compensation law. If a contractor or subcontractor is injured on your job site and they don't have their own workers' comp coverage, you may be held liable as the "statutory employer" in many states.

Always require certificates of insurance showing active workers' comp coverage from any subcontractor before work begins. Keep those certificates on file. This single step can protect you from significant unexpected liability.

Ask us: We can review your certificates of insurance and advise on your exposure with subcontractors before you sign contracts.