Claim Form

If a worker is injured while performing their normal job duties they may be entitled to workers' compensation benefits. All states have specific rules and regulations for reporting a worker's compensation claim. They also have a specific form the worker must use to report their workers' compensation claim, called a claim form. All claims must be submitted within a specified time frame.

All claim forms should be completed correctly according to your state's procedures and guidelines. In some states the injured employee must complete the form; other states require the employer to complete the form. Other states will require information from both the employee and the employer. Failure to complete the claim form correctly may result in loss of benefits.

All claim forms must be signed, dated, and returned to the employer. Employees should keep a copy of all forms submitted. Employers will review the claim form and decide whether to accept the claim or deny it. State laws allow varying times for approval. The employer is also required to complete the employer section of the form and send it to the insurance company. State laws determine how long the insurance company has to review the claim and send the injured worker notification whether their work comp claim is accepted or denied.

When injured workers have problems with their work comp claims they may need to go to the local workers' compensation office for help. Employers or insurance companies generally provide guides, samples, and information for injured workers about who to call and how to get problems resolved for their workers' compensation claim.