How Long Can a Workers’ Comp Claim Stay Open?

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The workers’ compensation claim process isn’t straightforward. Each state has different workers’ compensation laws that affect the process. One question insureds often ask is, “how long can workers’ comp claims stay open?”

When a work-related injury happens, the claims process begins. However, the amount of time a claim stays open, the procedural process, and what’s required of employers and their workers’ comp insurers varies based on the injury and the location of the claim.

The length of time a claim is open impacts the injured worker, your client, and their insurance costs. So, let’s walk through how long a claim should be open, the steps you and your client need to take, and why it’s important to have a plan for the workers’ comp claim process.

Reporting a workers’ comp injury

The first step after a work-related injury is to ensure the injured employee receives proper medical treatment.

Once the employee has medical care, you and your client must contact your workers’ comp insurance company. Many carriers require you to report an incident within 24 hours. The date of injury and when it’s reported will often dictate how long a claim is open due to investigations and other factors related to the claim.

Timing is everything

There’s also a time limit for employees to report an injury to their state workers’ comp office. Moreover, some states have a statute of limitations on when an employee can report a workplace injury and receive workers’ comp benefits.

You and your client will want to have an effective process in place to manage claims. For example, you’ll want to document the date of injury and how the employee was injured, including witness statements, and be prepared to disclose all of this information to your insurance carrier

How long can a workers’ comp claim stay open?

In most work-related injury situations, the workers’ comp claim will stay open until an employee is fully released by a medical professional to resume their regular job duties.

Workers’ compensation benefits may be paid even after an employee returns to work if they’re still undergoing medical treatment or can only perform light tasks.

Medical care may be required for serious injuries over the course of months or even years. However, employees can receive partial benefits if they still receive treatment after returning to work.

A back injury is a common workers’ comp claim that can remain open for a long time. It’s often a slow recovery process and can limit workers who perform manual tasks like lifting, pulling, and bending down.

In some cases, the insurance company may request an impairment rating evaluation (IRE). A third-party medical examiner will evaluate the whole body impairment of an injured worker to determine if they can return to the job.

Why it’s essential to close a claim quickly

It’s beneficial for everyone to close a workers’ comp claim as soon as possible. Workers’ compensation insurance is designed to support employees who are hurt on the job. So, the process needs to be smooth so they can receive benefits to cover medical bills and provide income while away from the job.

In addition, it’s beneficial for your client’s culture and morale of their workforce to show they take care of employees involved in a work-related injury.

Laura Koostra, VP of Recovery and Resolution at Foresight Workers' Comp
Laura Koostra, VP of Recovery and Resolution at Foresight Workers’ Comp

According to Laura Koostra, Vice President of Recovery and Resolution at Foresight, “Another important factor in closing a claim is ensuring that every injury receives the care and treatment appropriate to their diagnosis.  In fact, obtaining a correct diagnosis early can prevent unnecessary medical treatment, decrease the overall cost to the claim, and close claims faster.”

In situations where an employee is facing a severe injury and missing substantial time away from work, they may enter what is known as a stipulated agreement with the workers’ compensation insurance company.

This is a negotiated settlement between the employee and the insurance company, often leading to a lump sum payment to satisfy the claim. In most cases, the employee will seek counsel through a workers’ compensation attorney. Often, the injured worker will receive disability benefits to compensate them if they’re dealing with partial disability or permanent total disability.

Create a workers’ comp return to work plan

When a work-related injury happens, there comes a time in the process when an employee can return to work. Your client, the doctor administering medical treatment, and the employee must work together to determine how and when they’ll return. 

Develop a plan that’s best for the employee

A return to work plan is key in how long a workers comp claim stays open. The plan should be well-documented with defined dates and the type of tasks an employee will perform on the job.

The treating physician will dictate what the employee can do. They have the final sign-off for an employee to return to work, so they may prescribe shorter weeks or lighter tasks until they deem the injured worker healthy enough to resume their typical job duties.

Even if an employee returns to work in a limited capacity, they’ll still receive workers’ comp medical benefits to pay for their treatment.

Sometimes, a doctor may clear an employee against the wishes of the injured worker. However, according to most state laws, if an employee does not believe they’ve recovered, they have a right to appeal the decision to the state workers’ compensation board. Each workers’ comp case is different, but having a defined return to work strategy will benefit your client and their workforce.

Why your insurance company is so important

A strong relationship with your carrier is paramount when you and your client manage workers’ compensation claims.

The process is complicated. And many different parties are involved. Everyone has something they’re trying to accomplish and sometimes those interests are at odds.

Your carrier relationship affects the client relationship

That’s why you want a carrier who can walk you through the process and be there to support you, your client, and the injured worker. An insurer should ask the right questions and prioritize the employee’s health. Time is critical, so having a dedicated team to support your client can determine how long a workers compensation claim stays open.

And having a strong carrier partner can make a huge difference in your client relationship.

How Foresight does workers’ comp

The workers’ compensation claim process isn’t easy. It’s hard on the worker, your client, and you. That’s why we’re taking a different approach to workers’ compensation coverage.

We help our clients to reduce and eliminate work-related injuries through better safety practices. And our award-winning Safesite program, app, and risk consulting services are wrapped around each policy we write—at no extra cost. You and your client will work with a Safety Success Manager to develop a plan to keep their workplace and employees safer.

Technology empowers your client to be safer

If there is an incident, your client can record it on the Safesite App and reach out to us and we’ll be there to support the company and the employee.

Our specialty is hard to place class codes. We believe injuries don’t have to happen at work when the right safety strategies are used.

Over time, as your client implements strong safety practices successfully, the number of work-related injuries will be reduced. You can be part of changing workers’ compensation insurance. Get appointed today.

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Author: Foresight

We’re a team of compliance, safety, and commercial insurance professionals transforming workers compensation. We write about technology, trends, regulations, and value-adding services.