Workers' Compensation Process

Workers’ compensation is a type of insurance that helps employees to seek compensation in the event they’re unable to work totally or partially. Workers’ compensation also helps protect employers and affords them the ability to pay their employees in case of an injury. If a person has been injured at work, they can generally expect the process for filing a claim to go as follows.

Workers’ compensation laws are different in every state. It is essential to understand your state’s workers’ compensation process to ensure you can receive workers’ compensation benefits. Find a workers’ compensation attorney in your state for help and legal advice.

Seeking Medical Treatment for a Work-Related Injury

Employees need to get medical treatment immediately. If it is an emergency, the employee can go to a hospital’s emergency room. It’s crucial to discover the severity of the injuries and the best treatment as quickly as possible. Even if the employee doesn’t feel as though they’ve been injured or are not in pain, they should still seek treatment, as injuries may not become noticeable until later. If an employee waits too long to seek medical attention after the injury, it may impede the workers’ compensation process or approval.

According to some workers’ compensation policies, the injured worker may be required to see a certain medical provider. However, it is generally possible to seek a second opinion from another treating physician. Failure to seek health care altogether may cause the workers’ comp claim to be denied.

Employer Notification After an Injury

Employees should notify their employers, in writing, of any incidents as quickly as possible. However, the time period to inform employers of an injury can be anywhere between a few days to 45 days. Some states, like New York and California, require that employees notify their employers within 30 days. In Wyoming, workers must notify their employer within 72 hours of their injury. Other states, like Connecticut, require notification as soon as possible.

Failure to notify an employer can result in the inability to file a claim. Even if an employee notifies their employer informally, it is best to follow up with a form detailing the date and location of the injury or occupational illness. If you try and change your injury dates to file in time, it could be considered workers’ compensation fraud.

Official Claim Form After a Workplace Injury

Once an employee seeks medical treatment, a medical report and other information regarding the injury and general health will be recorded. A medical report is generally sufficient for a claim. Employers usually provide the official claim form, but if not, it can be obtained from the state board of workers’ compensation. The workers’ compensation form should include the following:

• The time, date, and location of the injury
• The names of people who were involved in the incident
• How the incident happened
• Whether or not the employee sought any medical treatment for the incident
• Contact information

After completing the workers’ compensation form, the employer files the employee’s claim with the insurer and the state board of workers’ compensation. After the claim is evaluated, an administrator will notify the employee whether it was approved and how much they might be entitled.

Worker’s Comp Benefits

Employees with approved claims may be entitled to different types of workers’ comp benefits, such as lost wages, medical bills, and vocational rehabilitation. However, employees generally cannot seek benefits for pain and suffering. The duration of benefits varies according to state. A general time frame for these wage and medical expenses benefits is between three and five years. In some cases, benefits may cease when an employee reaches age 65.

The amount that workers’ comp benefits usually cover is generally around 60 percent of the employee’s average weekly pay. However, an employee with a partial disability may expect a different amount. This is determined, first, by the employee’s current earning capacity.

Disability benefits can be classified as either partial or total and permanent or temporary. A temporary disability is, as the name implies. It is expected that an employee will recover from a temporary disability. A permanent disability is not likely to get better. A treating doctor may refer to permanent disability as a “maximum medical improvement,” as the employee has plateaued in recovery, and further treatment would not prove beneficial.

Total disability means that an employee cannot seek any work. Partial disability means that an employee has some capacity to work, but it may be limited to specific tasks. For instance, the employee may be unable to lift more than 10 pounds or be required to sit to perform work duties.

Appealing a Denial to the Workers’ Compensation Board

If an injured employee’s claim for workers’ compensation benefits is denied, they may choose to appeal the claim. Depending on the state, there may be a limit to how long the employee has to file an appeal. This information is generally included in the denial letter.

To appeal a case, an employee needs to know why they were denied. There are different reasons this could have occurred. Some examples of reasons why workers’ compensation claims can be denied include the following:

• The workplace accident was not reported in time
• The job-related injury is not eligible for workers’ comp
• The employer disputes the claim based on the medical records
• The type of injury cannot be compensated or does not necessarily require medical treatment
• Medical care was not sought in the allowed time frame
• There was insufficient evidence to support that the injury was caused by work
• Paperwork is filed improperly

Appeals will first go through the local state workers’ compensation board. If the denial is upheld, the workers’ comp claim process may continue up to higher levels of the courts, depending on the statutes in that state. Appeals can often be complicated to navigate. A workers’ comp lawyer can make the process easier by gathering and presenting documentation and further evidence.