Workers' Comp Claims & What to Expect
Meet Sarah MacDonald
Sarah MacDonald is a California workers' compensation defense attorney at MacDonald, Ebbing & Lloyd works with Eclipse Risk to defend employers from workers' compensation claims. With years of experience, Sarah is a wealth of information for employers navigating claims, as well as policy decisions.
What types of claims can I expect?
Some of claims will be what we call medical-only claims. This means that the injured worker reports a claim, receives treatment, and hopefully makes a full recovery. Other claims will be what we consider litigated. A claim becomes litigated when an applicant retains an attorney to represent his or her interest.
Who is notified first of a workers’ comp claim?
As the employer you will be the first to be made aware of a workers' compensation claim when it is filed. Sometimes you will be notified of a claim by your insurance broker or carrier if they are the first point of contact to receive notice that a claim has been filed. However, often times an applicant's attorney will not have your broker or carrier's information and will only send the notice of a claim to you. This notice could be in the form of a letter from the applicant's attorney requesting additional information, it could be the application for adjudication, or the claim for describing the alleged injuries. You may also receive a subpoena for documentation, such as wage statements or personnel records.
What should I do when I receive notice of claim?
It is important to provide all the information you have received regarding the claim filing to your broker or insurance carrier as soon as possible. The insurance carrier has certain notice requirements and timeframes to respond to any information regarding a new claim. They also only have a limited period of time to investigate the claim, to determine whether it should be accepted or denied. Therefore the more information you can provide as quickly as possible, the more time there is to investigate. If you do receive a subpoena for documentation, please provide that to your carrier and broker as well. This way you can ensure you are providing all relevant information, but not any information that could be considered privileged.
What happens after the claim is filed?
Once the claim has been setup, your adjuster should contact you to obtain additional information about the claim. If you have any information such as the applicant missing time from work, providing doctors notes, or reporting symptoms to a supervisor, you should notify your broker and adjuster of that. If you have any reason to dispute the claim, please be sure they are aware of those facts as well. Your adjuster or broker may also ask you for additional information, such as contact information for another employee that may have knowledge of the claim. Again, the more information you can provide at the early outset of the claim the better equipped your team will be to efficiently represent your interest.