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What Constitutes a Workers’ Comp Claim

When it comes to workers’ compensation, it is critical that you understand what your responsibilities are as a business. From purchasing workers’ compensation insurance to understanding what constitutes a claim, handling this aspect of your company’s human resources is a vital task.

Here at Integrity Employee Leasing, we assist businesses with workers’ compensation management. We can help you with everything from picking out a coverage plan to handling actual claims. Check out the following information about what constitutes as a workers’ comp claim and reach out to our team to learn more about how we can help you manage this aspect of running your business.  

Times A Claim Can Be Filed

Generally speaking, workers’ compensation is designed to protect an employee who is injured or harmed due to job-related duties. This could be anything from a back injury to an illness. A few requirements for when workers’ comp is applicable include the following:

  • The injury or illness must be job-related
  • The person must be an employee of the company, not a contractor
  • The incident must be reported in a timely manner

Common causes for workers’ comp include an injury that occurred while performing tasks on the job. For example, if an employee was hurt on a construction site while performing their duties, this could be considered a case for workers’ comp. Another example might be an illness that was the result of exposure to chemicals while performing work-related tasks. The bottom line is that whatever harm occurred, it needs to be directly related to the job being performed. For example, you can’t make a claim for an injury that occurred on your way to work and was unrelated to your job duties.

Factors That Lead To Non-Coverage<

While injuries that occur on the job are generally covered by workers’ compensation, there are certain factors that can cause a claim to be rejected. The general rule is that the harm that befell the employee has to be due to the job they are performing, not due to their own neglicence or contributing factor. A few examples of reasons that will cause a claim to be rejected include the following:

  • The employee was under the influence of drugs or alcohol at the time the injury ocurre
  • The employee was fighting or acting recklessly when the injury occurred
  • The employee was violating company policies or partaking in illegal activity at the time the injury occurred

A good way to measure whether or not something will fall under a workers’ compensation claim is to try to determine what the cause of the injury or illness is. Was it due to something that an employee could have prevented by following policies and procedures? Was it something outside of your employee’s control? Getting to the root of the cause will help you determine whether or not a claim is appropriate.

The Process Of Filing A Claim

Filing a workers’ compensation claim should happen as quickly as possible. Once the incident has occurred, a report should be filed with your company and then through your insurance company. It is important to keep detailed records of everything. Record the exact date and time the incident took place, as well as relevant information about the employee who was injured or harmed.

Having clear records goes a long way in making the process efficient and smooth. The more details you have, the better. The worst thing you can do as a business owner is to not take an employee’s claim seriously. You need to take action right away and go through the proper process for filing a claim.

Understanding The Timeline Of Claims

One of the reasons that it is important to file a claim in a timely manner is due to the various regulations in each state surrounding the length of time in which a claim must be made. In some states, an incident must be reported within a matter of days. In other states, you have up to a couple years to file a claim.


The timeframe for filing a claim will also be dependent upon what injury or illness is at hand. For example, if you had an injury occur, such as a back injury, the case will probably be more time sensitive. Conversely, if exposure to harmful chemicals resulted in an illness down the road, there might be more flexibility in the claim time. It is important to know your local laws and regulations surrounding the timeline for workers’ comp claims.

How You Can Prepare As A Business Owner

As a business owner, you, of course, want your employees to be safe and happy. You never want to see someone harmed on the job and you want your staff to have access to the medical care they need should an accident occur. The key to handling workers’ comp claims is to be prepared for these incidents before they arise.


The first place to begin is to make sure you have proper coverage. The majority of states require workers’ compensation insurance and you could face extensive fines for not carrying this vital policy. Not only should you have a good insurance policy in place, but you should also have clear directives for your employees on how to handle injuries in the workplace. Make sure that everyone knows what to do and how to file a workers’ comp claim.

If you need help with workers’ compensation management at your small business, we are here to help. We can ensure that you are meeting local and federal regulations while creating a safer environment for your employees. Reach out today to learn more about our HR services.

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