RateFast Definitions: Stakeholders in Workers’ Comp

A stakeholder is any party involved in a workers’ compensation claim. Any stakeholder in the claim has the ability to affect the claim in some way, though the extent varies from party to party.

The usuals

In every work comp claim, the stakeholders are:

  • The injured worker – The subject of the claim at hand. 
  • The PTP (primary treating physician) – The physician whom the worker sees that examines and rates the worker’s injuries.
  • The employer – The company or organization in charge of the facilities where the injury arose out of or in the course of.
  • The employer’s insurance carrier – The company responsible for paying the injured worker and the PTP. Having this responsibility entitles the insurance company to scrutinize and take action on the PTP’s findings.

When you need backup

Some work comp claims are disputed, and extra stakeholders may join to represent parties in the claim. Additional stakeholders may be:

  • QME (qualified medical examiner) – a physician usually representing the employer’s insurance, who will examine an injured worker when the employer’s insurance disputes a claim. A second opinion from a third party, if you will.
  • An attorney – because work comp claims involve money, things get complicated. An attorney can be hired by either the worker or the employer. The attorney has the right to order a deposition from the physician in disputed claims.
    • The injured worker may seek an attorney when the insurance refuses or delays the payment for an injury.
    • The employer’s insurance may seek an attorney when they are suspicious of the findings of the PTP, or the testimony of the injured worker.

As work comp claims snowball more stakeholders, they grow in complexity and expense.

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