What is a workers’ compensation claim?

A successful workers’ compensation claim depends on collaboration between several key participants:

• The employee: The employee reports the injury or illness, provides necessary details about how it occurred, and works with healthcare providers as needed throughout treatment and recovery.

• The employer: The employer reports the claim to their insurance provider promptly and provides all required documentation, including incident reports and witness statements. Employers also help coordinate communication with the insurer and the employee.

• The insurance company: The insurer reviews the claim, determines eligibility for benefits, and manages payments for approved medical costs and wage replacement.

• Healthcare providers: Doctors and other medical professionals evaluate, treat, and report on the employee’s condition, which helps determine benefits and potential return-to-work timelines.

• Insurance adjusters and case managers: In many cases, a claims adjuster is assigned to help ensure the claim is processed fairly, efficiently, and in accordance with state regulations.

Workers’ compensation claims have significant implications for both employers and employees.

For employees, the process provides critical financial protection, including access to medical care and income support, without the employee having to prove fault or pursue legal action. This helps workers focus on recovery and returning to work safely.

For employers, managing claims responsibly helps them comply with state regulations and protect against potential lawsuits. It also strengthens employee trust, boosts morale, and helps maintain a culture of safety. Businesses that handle claims promptly and with care often see smoother operations, lower costs over time, and better relationships with their employees.

Now that you understand what a workers’ compensation claim is, it’s important to know what to do next. Read our guide on how to file a workers’ compensation claim to learn what information you’ll need to submit your claim, and what to expect after filing.

You can also visit our Claims Center to submit a claim or find additional tools and resources to help you manage the process efficiently.