Workers' Compensation Process

Workers’ compensation is a type of insurance that helps employees with medical care and benefits after a job-related injury. Workers’ compensation insurance also gives employers a way to pay their employees in case of an injury. Most workers never learn about the workers’ comp process because they never need it. But if you do get injured at work, understanding the process and knowing what to expect is helpful.

Workers’ compensation laws differ in every state. It’s essential to understand your state’s workers’ compensation process to maximize your benefits. Contact a local workers’ compensation attorney for legal advice.

Seeking Medical Treatment for a Work-Related Injury

You need to get medical treatment for a workplace injury immediately. If it’s an emergency, call 9-1-1 or go to the emergency room. It’s crucial to discover the severity of the injuries and get first aid as quickly as possible. Even if you don’t think the injury is serious, you should still get medical treatment. Some injuries may not become noticeable until later.

Waiting too long to seek medical attention after your injury may complicate the workers’ compensation process. Failing to seek health care altogether is grounds for a denial of your workers’ comp claim.

In some states, you can go to any healthcare provider for treatment. Other states require injured workers to see a certain employer-approved medical provider. Find out about the workers’ compensation system in your state to understand where you can get care.

Reporting the Injury to Your Employer

You should notify your employer of any injuries or accidents as quickly as possible. You have a limited time to notify your employer under state workers’ compensation programs. Generally, the period to inform employers of an injury can be anywhere between a few days to 45 days. The workers’ compensation claims process can take longer if you wait to report the injury.

Generally, you can’t file a workers’ comp claim if you don’t notify your employer. You can report the injury directly to your supervisor and follow up with a written notice detailing the location and date of injury or illness.

Filing a Workers’ Compensation Claim

You can file a claim with your state workers’ compensation board. A workers’ compensation claim form details your injury or occupational disease. The workers’ compensation form should include the following:

• The time, date, and location of the injury
• The names of people involved in the incident
• How the incident happened
• Whether you sought any medical treatment for the incident
• Contact information

After completing the claim form, give a copy to your employer. Your employer will forward the claim to their workers’ compensation insurance provider. After the state board evaluates the claim, they will notify you of approval or denial. They’ll tell you how much you can get in wages and medical benefits.

Receiving Workers’ Compensation Benefits

You can get different workers’ comp benefits, including wage replacement benefits, medical care, and vocational rehabilitation. Generally, you can’t seek benefits for pain and suffering or non-economic damages. The benefit duration varies by state to a maximum period of the benefit term. If you suffer permanent disability because of a workplace injury, you can apply for disability benefits.

The workers’ comp benefit amount also varies by state. Generally, income benefits are around 60% or two-thirds of the employee’s average weekly pay, up to a maximum amount.

Disability benefits are either partial or total and permanent or temporary. A temporary disability is a limited injury with the expectation you will be able to return to work. A permanent disability is not likely to get better. A treating doctor may refer to permanent disability as reaching maximum medical improvement (MMI).

Total disability means you cannot work. Partial disability means you have some capacity to work but with limited or specific tasks. For instance, you may be unable to lift more than 10 pounds or have to sit to perform work duties.

Appealing a Denial to the Workers’ Compensation Board

If the insurance company denies your workers’ compensation benefits, you can appeal the claim. Depending on the state, there may be a limit to how you have to file an appeal. This information is generally included in the denial letter.

To appeal a denied workers’ comp claim, you need to know the reasons why. An insurance carrier can deny workers’ compensation claims for the following reasons:

• The workplace accident was not reported in time
• The job-related injury is not eligible for workers’ comp
• The employer disputes the employee’s claim based on the medical records
• The employee was under the influence of alcohol at the time of injury
• The injured employee didn’t seek medical attention
• There was insufficient evidence to support that the injury was work-related
• Administrative errors

Appeals will first go through the local division of workers’ compensation. If the denial is upheld, the workers’ comp claim process may continue up to higher levels of the courts. Contact a workers’ comp appeals attorney for information about the appeals process.

Help Navigating the Workers’ Compensation Process

Navigating the workers’ compensation process is complicated. When the insurance adjuster denies an injured worker’s claim, many people just accept the outcome without fighting back. A workers’ comp lawyer can review your case and explain your legal options.

Your lawyer can negotiate with the insurance company to approve your claim. They can also take legal action in court to make sure you get your benefits. Speak to a workers’ compensation lawyer for help with the claims process.