How does a third party administrator evaluate a workers’ compensation claim?

Workers’ Compensation is designed to be there for employees who are facing work-related injuries. Of course, before a claim can be paid and settled, it needs to be evaluated by a few different sources.

First, the employer will have to determine whether a claim may be filed. Then, the insurance provider that offers the workers’ comp coverage will evaluate the claim to ensure that it is legitimate and compensable. Third parties, such as your lawyer or your employer’s lawyer, may also review the case.

When a third party administrator is evaluating a workers’ compensation claim, they will look at all of the basic elements to ensure that the case is legitimate and all of the regulations are being followed. They will look for things like: 

  • evidence to support that the injury is work-related;
  • details and circumstances of the injury accident (how, why, where, when, etc.);
  • whether the injury falls under the workers’ compensation coverage with the specific employer; and
  • whether the claim falls under the laws of the state and jurisdiction where the injury occurred.

All of these elements may be used to determine the validity of the claim, as well as how much compensation to which the injured party is entitled. When dealing with any type of work injury, it helps if you have a Richmond work injury lawyer on your side.

You can learn more about Workers’ Compensation and get your FREE Workers’ Compensation Guide today from the Injured Workers Law Firm. Call today at 877-755-7744 to discuss your case.

2016-10-30T13:43:03+00:00

About the Author:

The Injured Workers Law Firm is a Richmond, Virginia based firm solely focused on serving clients with workers' compensation claims in Virginia. If you have questions about your benefits or if you would like more information on the Virginia Workers’ Compensation system, order our book, “The Ultimate Guide to Workers’ Compensation in Virginia” , or call our office today (804) 755-7755.