Workers Compensation Claim Process
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Workers’ Compensation Claim Process
Brandee Ralls
HCR 230
July 25, 2011
LaShay M. Martin
Workers’ Compensation Claim Process
The workers’ compensation program is divided between federal compensation and State compensation. The federal Department of Labor runs and regulates four disability compensation programs that ensure the workers of the federal government have coverage incase of a work related injury or work related disease. Each state has two types of workers compensation programs that are state funded and not federal. These programs and benefits may vary from state to state because every State can govern their own rules and regulations. It is necessary to have both State and federal compensation plans because they both cover different workers and their injuries as it pertains to the severity of their work force. Both federal and state programs have rules and regulations they must take into consideration such as the claims process to include, responsibilities of the employee, employer, physician, and insurance carrier, HIPAA Privacy Rules, and patient medical records.
The claims process first starts by the worker obtaining necessary medical treatment usually by an in network doctor pre selected by the employer or the insurance provider and notifying his or her employer in writing about the incident and how it happened within a specific time period. If the employee chooses not to be seen by the selected medical provider he/she can be denied for workers’ compensation. The employer then has to make notifications within a specific time period to the workers’ compensation office and insurance provider.
The physician of record is responsible for all medical services and recommendations that pertain to the related injury. This includes recommended disability and return to work date. According to Valerius, Bayes, Newby & Seggern (2008), “the physician of record files a progress report with the insurance carrier every time there...
Brandee Ralls
HCR 230
July 25, 2011
LaShay M. Martin
Workers’ Compensation Claim Process
The workers’ compensation program is divided between federal compensation and State compensation. The federal Department of Labor runs and regulates four disability compensation programs that ensure the workers of the federal government have coverage incase of a work related injury or work related disease. Each state has two types of workers compensation programs that are state funded and not federal. These programs and benefits may vary from state to state because every State can govern their own rules and regulations. It is necessary to have both State and federal compensation plans because they both cover different workers and their injuries as it pertains to the severity of their work force. Both federal and state programs have rules and regulations they must take into consideration such as the claims process to include, responsibilities of the employee, employer, physician, and insurance carrier, HIPAA Privacy Rules, and patient medical records.
The claims process first starts by the worker obtaining necessary medical treatment usually by an in network doctor pre selected by the employer or the insurance provider and notifying his or her employer in writing about the incident and how it happened within a specific time period. If the employee chooses not to be seen by the selected medical provider he/she can be denied for workers’ compensation. The employer then has to make notifications within a specific time period to the workers’ compensation office and insurance provider.
The physician of record is responsible for all medical services and recommendations that pertain to the related injury. This includes recommended disability and return to work date. According to Valerius, Bayes, Newby & Seggern (2008), “the physician of record files a progress report with the insurance carrier every time there...