Steps in a Worker’s Compensation Claim
Step 1 – An employee is hurt on the job
An employee who is hurt on the job is entitled to worker’s compensation as long as the injury fits the criteria for a compensable claim, namely the injury occurred by accident and it was “arising out of” the employment and “in the course of” the employment. Both criteria—“arising out of” and “in the course of”—must be met to qualify as a compensable claim.
An accident that occurs “in the course of” employment is one that takes place during the period of employment at a place where the employee would normally be or have cause to be during the course of employment and is fulling the duties associated with the employee’s employment. See, e.g., Ward v. Lowe’s, 76 N.E.3d 918, 921 (Ind. Ct. App. 2017) (citation omitted). An injury “arising out of” the employment is one where there is a causal connection between the injury and the worker’s employment. See, e.g., Global Const., Inc. v. March, 813 N.E.2d 1163, 1168 (Ind. 2004) (citation omitted); Wine-Settergren v. Lamey, 716 N.E.2d 381, 389 (Ind. 1999) (citations omitted).
Step 2 – Contact your insurance carrier
Contact your worker’s compensation insurer as soon as possible. A claims adjuster will like be assigned to your case and will work with you through the details of the claim. Information you will likely need includes:
•Date of injury
•Injured person’s job title
•WC insurance information
•Type of injury
•Body part(s) involved
•Brief description of how injury occurred
By failing to give prompt notice, your coverage could be impacted.
Step 3 – Ensure that your Adjuster has completed the First Report of Injury Form
Typically, the adjuster will prepare and file the First Report of Injury using State Form 34401.
Step 4 – Claim Processing
After a claim has been filed, traditionally the employer will step out of the process and the adjuster will work directly with the employee regarding his or her medical claims.
Step 5 – Claim Decision
The employer/insurance company will determine compensability. If the claim is compensable, the employer will pay benefits. If the claim is denied, the claim becomes a disputed claim.
Disputed claims can either proceed to a hearing before the Indiana Worker’s Compensation Board or the parties can elect to utilize a Section 15 settlement agreement. Contact your legal counsel or a member of Barrett McNagny’s Worker’s Compensation group to discuss your options for a disputed claim.