The workers’ compensation claim process can be complex, with different laws and regulations varying from state to state. One common question asked is, “how long can workers’ comp claims stay open?” In this article, we’ll explore the duration of a claim, the steps involved, and why it’s important to have a plan in place.
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Reporting a Workers’ Comp Injury
After a work-related injury, the first priority is to ensure the employee receives proper medical treatment. Once the employee is cared for, the next step is to contact the workers’ comp insurance company. Many carriers have a 24-hour reporting requirement, as the date of injury and prompt reporting can influence the duration of the claim.
Timing is Everything
Employees also have a time limit to report injuries to their state workers’ comp office. Some states even have a statute of limitations on when an injury can be reported to receive benefits. To manage claims effectively, it’s crucial to have a process in place to document the date and circumstances of the injury, including witness statements, and provide this information to the insurance carrier.
How Long Can a Workers’ Comp Claim Stay Open?
In most cases, a workers’ comp claim remains open until the employee is fully released by a medical professional to resume regular job duties. Benefits may continue even after an employee returns to work if they require ongoing medical treatment or can only perform light tasks. Serious injuries may require months or even years of medical care, but partial benefits can be provided if treatment continues after the return to work.
A common example is a back injury, which often has a slow recovery process and can restrict manual tasks such as lifting, pulling, and bending down. In some instances, the insurance company may request an impairment rating evaluation (IRE) by a third-party medical examiner to determine if the employee can return to the job.
Why It’s Essential to Close a Claim Quickly
Closing a workers’ comp claim as soon as possible benefits everyone involved. The purpose of workers’ compensation insurance is to support employees injured on the job, providing coverage for medical bills and income while away from work. It also demonstrates your client’s commitment to taking care of their employees, fostering a positive company culture and morale.
According to Laura Koostra, Vice President of Recovery and Resolution at Foresight, closing a claim promptly also ensures that the injured employee receives appropriate care and treatment. Obtaining an accurate diagnosis early can prevent unnecessary medical treatment, reduce overall claim costs, and expedite claim closure.
In cases where an employee faces a severe injury and extended time away from work, they may enter into a stipulated agreement with the workers’ compensation insurance company. This negotiation often leads to a lump sum payment to settle the claim. Typically, the employee seeks counsel from a workers’ compensation attorney and may receive disability benefits for partial or total disability.
Create a Workers’ Comp Return-to-Work Plan
When an employee is ready to return to work after a work-related injury, collaboration between your client, the treating physician, and the employee is vital. Developing a well-documented return-to-work plan with defined dates and tasks helps determine the duration of a workers’ comp claim.
Develop a Plan that’s Best for the Employee
The treating physician has the final say on an employee’s ability to return to work. They may prescribe shorter workweeks or lighter tasks until they believe the employee is healthy enough to resume regular duties. Even if an employee returns in a limited capacity, they are still eligible for workers’ comp medical benefits to cover ongoing treatment. If an employee disagrees with the physician’s decision, they have the right to appeal it to the state workers’ compensation board.
Why Your Insurance Company Matters
Maintaining a strong relationship with your carrier is essential when managing workers’ compensation claims. The process involves multiple parties with differing interests, and having a carrier that can guide you through the process and prioritize the employee’s health is crucial. Timely response and dedicated support from a carrier can significantly impact the duration of a workers’ comp claim and positively influence your client relationship.
How Foresight Does Workers’ Comp
Handling workers’ compensation claims can be challenging for all parties involved. Foresight takes a different approach to workers’ compensation coverage, prioritizing safety practices to reduce and eliminate work-related injuries. They provide the Safesite program, app, and risk consulting services alongside each policy, at no extra cost. Collaboration with a Safety Success Manager helps develop a customized plan for a safer workplace and employees.
Technology Empowers Clients to Be Safer
Using the Safesite App, clients can easily record incidents and seek prompt support from Foresight in case of an injury. Foresight specializes in hard-to-place class codes and believes that with the right safety strategies, injuries don’t have to happen at work. As clients implement robust safety practices, the number of work-related injuries decreases, making a positive impact on workers’ compensation insurance. Join Foresight today to be part of this transformative change.