Complete Guide to Construction Workers’ Compensation Claims

Workers’ compensation is one of the most important types of insurance you need for your construction business. Whether it’s an injury on the job or a work-related illness, workers’ compensation ensures you and your employees are covered.

From medical bills to lost wages, rehabilitation, and death benefits, there’s a reason some states insist on an insurance policy for high-risk industries. It’s about protecting both parties in the event of unforeseen circumstances. However, having the insurance in place is one piece of the puzzle.

Navigating the actual claims is the second part. That’s why we’ve put together a complete guide to construction workers’  comp claims where you’ll learn it’s a straightforward process (and there are even tools out there to help you with it).

What is Workers’ Compensation Insurance?

The concept of workers’ compensation dates back to 2050 BC. You can find compensation payments for a work-related injury in documents from ancient Sumeria. They appear again in Greek, Roman, and Asian societies throughout history.

In today’s society, workers’ compensation insurance, colloquially known as “workers’ comp,” is essential for business owners. The idea of protecting both business and employee from injury is a no-brainer, no matter the size of your company.

If you’re in a risky industry like construction, workers’ comp is crucial. It covers medical bills, rehabilitation, and wage loss (something that’s certainly come to light during the COVID-19 pandemic). If an employee is injured fatally on the job site, death benefits kick in for their family. A workers’ comp policy will also protect you from lawsuits, covering legal costs should an employee sue you for negligence.
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Common Reasons Why Workers’ Comp Claims Are Disputed By Carriers

According to the Insurance Journal, the top five injury claims for workers’ comp in construction are:

1. Strains and sprains
2. Cuts or punctures
3. Contusions
4. Inflammation
5. Fractures

The most frequent causes of workplace injuries on construction sites include:

1. Handling material
2. Trips or falls on the job site
3. Collision with an object or piece of machinery
4. An accident with tools or equipment
5. Traumas caused by overuse or strain

While workers’ compensation sets out to protect you and your employees from the financial implications of accident and injury, there are a few common reasons why a claim could be denied. Ensure that you’re operating above board for the following:

• Safety compliance
• Lost profits on projects left uncompleted – a concern lots of businesses faced when COVID-19 hit.
• Liability for any construction defects

When you’re submitting claims for workers’ compensation, ensure you’ve considered the following scenarios:

• Returning to work: As an employer, you may want your employee to return to work as soon as possible. Make sure to note (and follow) the time frame provided by a healthcare professional, so your employee has full clearance to get back to work
• Injury severity: Insurance providers will want to know how serious the injury is, so make sure you have a medical evaluation on hand to give them a clear picture of your employee’s injury.
• Prior injuries: Remember to document the history of the employee. Even if the injury in question is an aggravated pre-existing condition, they’re entitled to compensation.
• Where the injury occurred: You must ascertain from the get-go where the injury occurred. Remember, this is a workers’ comp claim, so the injury has to have occurred on the job…the better you can pinpoint the actual location (and time) of the injury, the better the claims process will go.

4 Tips To Keep Claims From Derailing Your Business

1. Document Everything

The first and most crucial step to any workers’ comp claim will be a paper trail. It would be best if you documented every incident that occurs on-site.

Whether you directly witness something, a co-worker informs you, or you simply notice some discomfort, write it down. It is your responsibility to inquire and collect all the relevant information from your employee. Now would be the time to uncover any pre-existing conditions and ask about any previous compensation claims.

If the incident happened in front of witnesses, you’d need to document their statements. If there are any surveillance cameras in the area, obtain the footage and add it to your records. At times, it may feel like you’re overreacting by documenting all this information. It’ll undoubtedly be worth it should you need to submit a claim: the more detail, the better.

It’s also important to note that multiple parties could be liable on construction sites in particular. From property owners to general contractors and subcontractors, it’s essential to document everything so it’s clear who is responsible for the accident.

2. Offer Medical Care

As soon as the injury occurs, you need to express concern, offering immediate medical care. While this feels like an obvious reaction, it’s easy to come off as unsympathetic in the face of paperwork and construction delays.

On top of showing a sense of concern and compassion, you can ensure the employee sees a medical practitioner of your choosing. They will help you determine the seriousness of the injury, giving you an honest evaluation. Immediate action fosters a sense of goodwill with your employee, which will only assist you in the overall process.
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3. Understand Your State Laws

Make sure you’re following the process according to your state’s specific workers’ comp laws. You can work closely with your insurance broker to get advice on the parameters.

With any worker’s comp claim, the authorized medical provider who evaluated the injured employee needs to be very specific. Depending on your state, the rights of the injured employee may vary. It helps to know what your parameters are. By understanding the specifics of your state’s laws, you could save your company considerable resources.

4. Start Slowly

After your employee is clear to return to work, it makes sense to implement a transitional program. Depending on their clearance, they may have total or limited capacity. Work with their doctors to determine a schedule that falls within their recovery plan.

Transitional light-duty programs demonstrate compassion and care for employees, showing them that you value their involvement for the long term. Light-duty work on a construction site could be anything from office work to operating stationary machinery or training new employees. While there may not be an abundance of this on your site, find a way for your employee to start slowly.

How To File A Workers’ Comp Claim

Step 1: Report the injury

Start by putting together a report including all the essential information related to the injury or illness. It should include:

• How the accident happened
• The type of injury
• Any data related to the accident itself

Remember, the more detail, the better!  The start date should be the first time the employee missed work or had to see a doctor for their symptoms.

Step 2: Complete the claim form

Give the injured employee a claim form to complete within one day of the injury or illness. Both employee and employer must complete the form in its entirety.

Step 3: Submit the claim

Once the claim form is complete, you’ll need to submit it to your insurance company. The claim will then be approved or denied. Generally, this will happen within 90 days. Depending on your state, the insurer is responsible for medical bills up to $10,000 while the claim is under review.

Make a Claim the First Three Months After an Injury

The first 30 to 90 days of any worker’s compensation claim are the most consequential. Start the process on the right foot by incorporating these measures into your administrative flow. If you do things by the book, the claims process will be straightforward and protect you, and your employees.
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Make Workers’ Comp Easier Before You Even Get to the Claims Process

Now that you know how to file a workers’ comp claim, you can dive into making workers’ comp (on the whole) and the audit process a lot easier for you. Take the stress out of workers’ comp with a platform like Hourly. It syncs your real-time payroll data with workers’ comp, so premiums are based on actual wages, not estimates. What does this mean for you? No more surprises on your workers’ comp audits! You’ll pay for what you need, when you need it, which is a massive win for your company.

Emma Dittmer

Emma Dittmer is the Marketing Manager at UCOOK, South Africa's leading dinner-kit service and contributing writer on Hourly Inc. Dedicated to sharing the knowledge she's gathered over the years, she now writes for various publishers. Working in a start-up environment means she's well versed in the fast-paced, exciting world of e-commerce and all things digital.