Understanding The Workers' Comp Claim Process (2026)

What Is the Workers' Compensation Claims Process?

The workers' comp claim process is fairly similar from state to state. Employers who have workers’ compensation insurance pay monthly premiums. If a worker gets injured on the job, they file a claim for benefits.

Workers’ comp benefits vary by state, but if a claim is approved, the injured employee might qualify for the following:

• Medical treatment
• Temporary wage replacement benefits
• Long-term wage replacement (if the injury leads to a permanent disability)

If a worker dies on the job, their family might qualify to receive a death benefit.

Step-by-Step Guide to Filing a Workers' Comp Claim

In most states, the workers’ comp claim process involves the following steps:

• Reporting the injury to your employer in writing
• Seeking medical care
• Gathering and keeping medical documentation
• Submitting your claim along with the doctor’s assessment
• Cooperating with the insurance company’s investigation

If your claim is denied, you can usually file an appeal. It’s strongly recommended that you have a lawyer to help you do this.

Employee's First Steps: Reporting the Workplace Injury

If you get hurt on the job, you’re generally required to notify your employer before filing a claim. Usually, you must do this in writing. Different states have different deadlines:

• Tennessee gives employees 15 days.
• South Dakota has a three-day reporting deadline.
• California gives you three days.

Some states just require employees to report injuries “as soon as possible.”

Getting Medical Treatment After a Work Injury

If you’ve been severely injured at work and need emergency medical attention, there likely won’t be time for your employer to tell you about in-network doctors. Workers’ comp will usually cover emergency care at any hospital.

When the hospital asks about billing, make it clear that you’re being treated for a work injury and offer your employer’s information.

For non-emergency treatment, many states require your employer to give you a list of approved, in-network doctors to choose from. If you choose one provider and later want to make an adjustment, a workers’ comp lawyer may be able to help you do so.

Employer Responsibilities in the Claims Process

The workers’ compensation system was created so employees wouldn’t need to file personal injury lawsuits for work injuries. Workers’ compensation is a no-fault system, and employers have important responsibilities:

• Reporting the injury to their insurance provider right away
• Providing the employee with a list of approved doctors (if applicable)
• Conducting a thorough investigation
• Not discriminating
• Not retaliating against the employee for filing a claim

Employer retaliation for filing a workers’ comp claim is a violation of the law. If your employer retaliates against you, you should contact a lawyer right away.

How Insurance Companies Investigate and Decide Claims

Once you have submitted your workers’ comp claim, the insurance company will investigate. Workers’ comp insurance providers are usually very thorough, and the investigation may include the following:

• Talking to you, your employer and your medical provider
• Having an independent medical examiner (IME) review the claim
• Interviewing witnesses
• Assessing workplace safety
• Reviewing security footage of the incident (if available)
• Reviewing your medical records

Insurance companies will also look for anything that could disqualify you from benefits eligibility. For example, if you were under the influence of drugs or alcohol when you were injured, workers’ comp probably won’t cover you.

Likewise, if you were roughhousing with other employees or willfully breaking safety guidelines, you generally will not qualify.

Return to Work Plans and Recovery

In some cases, you may be able to return to work with no limitations. However, if you have lingering symptoms or some level of disability, you and your employer may need to create a plan for your return. This plan may include modified duties or limited hours as you readjust.

Sometimes, your injury may prevent you from working with your previous employer at all. Some states have workers’ comp programs that offer vocational rehabilitation. You might qualify for funding for job retraining or be able to work with a career counselor.

What Happens When a Claim Is Denied or Disputed?

If your workers’ compensation claim is denied or disputed, don’t panic. You can generally file an appeal, although each state’s procedures for doing so are slightly different.

You aren’t required to have a lawyer to file an appeal, but it’s a good idea to retain an attorney before you do so. Many workers’ comp insurance companies will fight back against claims they don’t want to approve. Workers’ comp attorneys understand their tactics and know how to build convincing cases.

Get Skilled Legal Help With Your Workers' Comp Claim

Some workers’ comp claims are fairly straightforward. However, if you’ve been seriously injured or you’re having trouble getting your benefits, you should consult a workers’ compensation lawyer immediately.

If you don’t already have an attorney, ConsumerShield can help you find one. Fill out our contact form below to start with a free case evaluation.