Filing a Workers’ Comp Claim, and What to Expect from Your Adjuster

Once they start working for an employer, employees are protected under the workers’ compensation system. This means that if you suffer a work injury or illness, you are entitled to workers’ compensation benefits. Here is how to file a workers’ comp claim, and what to expect from your adjuster during the process.

I’ve Suffered a Work Injury. What Should I Do?

Report the work injury to your employer right away, the sooner the better. Depending on where you work, you might be informing a manager, supervisor, on-site physician, or a staff member in an HR department. Make sure they document the reporting of your work injury.

What is the Deadline for Reporting the Work Injury?

You must report the work injury within 180 days. But again, it is best to do so immediately, or as soon as you realize your injury or illness is directly linked to your job.

I Reported My Work Injury. Now What Happens?

The employer will then have 7 days to report the claim to the insurance carrier for the business. Following that, the insurance carrier has 14 days to file a Form 122 (First Report of Injury) to the Industrial Accidents Division. A copy of this report must be provided to the injured worker, along with a copy of Form 100 (Injured Workers’ Rights and Responsibilities).

What Doctor Do I Visit?

Your employer should direct you to a designated medical provider. If there is no preferred provider, then you may choose the doctor (one who accepts workers’ compensation insurance). Make sure your employer provides you with contact information for the workers’ compensation insurance carrier and their policy number, which the medical provider will likely request. Explain your injury to the doctor, and note when and where the accident happened at work. (Or in the case of an illness, note how it is a result of the job tasks you perform.)

Does the Doctor Need a Form?

The doctor will need to complete a Form 123 (Physician’s Initial Report of the Injury or Illness) and submit it to the Industrial Accidents Division within 7 days of your first doctor visit. You, the employer, and the insurance carrier should each receive a copy of this form.

I Haven’t Heard Anything from the Adjuster Yet…

After reporting your work injury, it may take some time for the insurance carrier adjuster to contact you. It does not necessarily mean they are ignoring your case.

How Long Do I Have to Wait for the Insurance Carrier to Respond?

Once they receive a report from either the employer or doctor (or reports from both), the insurance carrier will open a workers’ compensation claim. They will then have 21 days to determine if your case is eligible for workers’ compensation benefits. In instances when they require further investigation, the insurance carrier may take an additional 24 days to accept or deny the claim. (That would make 45 days total.) They would file this extension by submitting a Form 441 (Insurance Carrier Notice of Further Notification of Claim) to the Industrial Accidents Division. They must mail a copy of this form to you as well.

What Happens if My Claim is Approved?

The insurance carrier will send a Form 141 (Initial Statement of Insurance Carrier with Respect to Payments of Benefits) plus the first indemnity payment if you have lost work due to the injury (when more than three days of work were lost). Depending on the compensation benefits for time lost and/or decreased wages, the insurance carrier will need to contact the employer for your weekly pay at the time of the work accident. The adjuster should work directly with you to determine what medical benefits the insurance carrier needs to pay directly.

What If My Claim is Denied?

You will receive a Form 89 (Employee Notification of Denial or Partial Denial of a Claim). You can speak with the claims adjuster to ask why it was denied. In certain cases, you may be able to resolve an issue by providing more information that the insurance carrier requires. But if the claim is still denied, you can contact the Industrial Accidents Division via the Intake Claims Department. If the claims staff can not resolve the dispute, you can file an Application for Hearing with the Labor Commission’s Adjudication Division. You can contact them for more information at (801) 530-6800. You can also request to participate in a Claims Resolution Conference, which assists in resolving workers’ compensation disputes.

About the Claims Adjuster

The claims adjuster is the insurance carrier worker who will either approve or deny payment for your medical treatments and your wage-loss benefits (from days missed work, decreased working hours, etc). The adjuster will gather information from your employer regarding the accident. They will also ask you for all your pertinent medical records and any other documents that can help them determine if your injury is work-related.

Communicating with the Claims Adjuster

You will likely need to answer questions about your injury, your reporting of the accident, and all your related doctor visits. Though the adjuster is assisting you with the workers’ comp claim, keep in mind that their goal is to close your case as cheaply as possible. They may ultimately deny your benefits outright, or encourage you to settle your case for a lower amount than you deserve. There is also a chance they will take a lengthy amount of time to respond to any of your inquiries, delaying the process of your claim and the treatment of your injury.

I Haven’t Heard from the Adjuster in a While… What Can I Do to Be Proactive?

• Once you and your adjuster make contact, you can check in on your case regularly. If you speak on the phone or leave a message (either by voice or text), follow up with an email to keep track of all your interactions. A “paper trail” may be helpful for future reference.
• When questioned, always stick to the basic facts of your injury. Be honest and consistent, and avoid rambling or going off-topic. You don’t need to answer questions unrelated to your case, or sign documents without looking them over carefully first.
• Make sure your forms are fully complete. Report all issues related to your work accident. If, say, you primarily injured your left leg, but your left foot has also been hurting—make sure you mention the pain in your foot in the reports too.
• Submit forms and other required materials promptly to keep your case moving along without further delay.
• Consult an experienced lawyer for assistance. A Rose Legal workers’ comp attorney can guide you through the appeals process and help ensure you receive all the benefits you’re entitled to. If you have questions at any point along the way, you can reach us at 801-810-7673.

Example Timeline

In this example, the worker suffers a work injury on April 1st and reports it to the employer on the same day. The employer has 7 days to report to the insurance carrier, so that deadline is April 8th. The insurance carrier then has 14 days to report to the Industrial Accidents Division of the Utah Labor Commission (ULC), so if the employer notified them on April 8th, then the insurance carrier’s deadline is April 22nd.

Meanwhile the deadline for the insurance carrier to accept or deny the claim would be April 29th, since that is 21 days after April 8th (the day the employer reported the injury to the insurance carrier). But if the insurance carrier files for an extension of 24 additional days, then the deadline moves to May 23rd. In summary, it can take up to about eight weeks to get a final answer from the insurance carrier regarding your workers’ compensation claim.