Workers’ Compensation Claims Process: How to File Your Claim

By / January 22, 2017 / Workers Compensation / No Comments

A detailed outline of the worker’s compensation claims process and how you can file today to begin receiving benefits for your work related injury.

If you suffer a work-related injury or illness, you should first get immediate medical care if required to treat it. Next, notify your employer, verbally and in writing. If you are a member of a Union, notify them as well. Depending on the state where your injury or illness occurred, notification should take place within a few days or weeks. (In a few states you must file within two years.) It is recommended that you file an Accident Report with your employer and put in your Workers’ Compensation claim as soon as possible, as this may make it easier to verify your injury or illness is work-related.

Most states require companies to post Workers’ Compensation claims procedures in a common area for all to see. Obtain Workers’ Compensation claim forms from your employer to fill out and submit if they have them on hand. If not, you can obtain them from the Workers’ Compensation agency in the state where your accident or illness occurred — not the state where you live, if different. Depending on the state, you may also need to submit a copy of the Workers’ Compensation claim form to your employer, to the state agency, or to both. The sooner you file, the better.

If your employer or their insurance carrier does not dispute your claim, it will be approved. Next, an insurance adjuster or your employer will provide instructions on how to submit your medical bills for payment or reimbursement.

Typically, you would be covered for the cost of doctors, nurses (including home care if necessary), hospitals or clinics, physical therapy, medical supplies, dental care, chiropractic care, prosthetic devices — whatever may be required.

If you suffered a temporary injury, with no loss of income, those bills will be paid promptly (in most cases). Should you be unable to work because of your injury, also expect to receive payments to cover some or all of your lost wages.

If you are expected to recover and go back to work, Workers’ Compensation will send you tax-free temporary disability payments. However, if you are unable to return to work, you may be paid, on a regular basis, two-thirds of your average wages…or a lump sum. The amount is set by the state’s Workers’ Compensation agency, and varies from state to state and by industry.

In the event of death from a work-related injury or occupational illness, a death benefit is usually paid to the spouse or dependent children of the worker. Usually, the amount is two-thirds of the worker’s weekly salary and is paid weekly. In many states, the total amount paid is limited, while other states limit the length of time the benefit is paid.

Death benefits to spouses usually cease if the spouse remarries, although in some states a lump sum is then paid.

Death benefits to surviving children usually cease when the children reach adulthood unless they’re full-time students.

Burial expenses may also be paid.

Should A Lawsuit Be Filed During the Workers’ Compensation Claims Process?
Whether or not any claims for Workers’ Compensation are filed, injured workers — or the survivors of workers killed on the job — have the option of filing lawsuits for negligence against the party (e.g., manufacturer of a defective factory machine) they consider responsible for the injury or death.

Or they might sue their employer, accusing the company of failing to maintain a safe workplace, failing to carry the required amount of Workers’ Compensation coverage, or violating the laws of the Workers’ Compensation system.

If a lawsuit is contemplated, it is highly recommended that an experienced lawyer be hired to handle it. In many states, the services of a lawyer are required.

Documenting Your Case For Worker’s Compensation Benefits
It is important to keep a notebook or file of everything pertaining to your injury or illness. Document everything:

  • Location of the accident or injury?
  • The date and time.
  • Who witnessed the accident?
  • What exactly happened to you? (i.e. Did you slip and fall? If so, what caused you to slip? Did you hit anything else on your way to the ground?)
  • When and how did you inform your company or immediate supervisor? Etc.

Keep copies of every form you fill out and submit. Keep a diary of the doctors you see and the tests and treatments you get. Keep track of your symptoms and report to your doctor regularly. (Some states require you see your doctor every 45 days, for example.) Keep track of all expenses you incur, and check to see that they are paid.

You may be required to visit doctors within the insurance company’s network of providers. You should also have a doctor of your own choosing, even if you have to pay out-of-pocket, to evaluate your condition without being under the influence of the insurance company. You want someone who is looking to provide you with the best assessment and treatment for your needs.

If you are asked to get an Independent Medical Examination, be sure you keep the appointment. This is your employer’s insurance company’s way of confirming what your doctors and other medical professionals you’ve seen are saying about your injury or illness, and recovery process. The doctor performing the exam is working for the insurance company, and will not treat your or prescribe medication. He or she will be looking for reasons to minimize or disprove your disability claim, and stop paying your benefits.

Your doctors and medical facilities will submit invoices directly to the insurance company or your employer, and you will need to keep track of your receipts for travel expenses to and from doctor appointments and testing and treatment centers. You will submit these for payment yourself. Make note of when you sent the claims and when they were paid.

What to Do If Your Workers’ Compensation Claim Is Contested or Denied
If your claim for Workers’ Compensation benefits is contested or denied, you should double-check your rights, review your claim with your doctor and an attorney, and then decide if you wish to appeal.

An attorney can help you choose one of the following courses of action:

Appeal—In most states, you can file an appeal if your claim is denied. It helps to have an attorney to guide you and strengthen your claim if it is not as strong as it could be. You may need to have additional statements from medical experts, safety engineers, witnesses or others to support your case.

Mediation—An independent, objective mediator, with expert knowledge of the Workers’ Compensation system, is chosen to help both sides communicate to resolve the problem.

Arbitration—If both sides agree on the issue but can’t come to an agreement on what to do, an independent arbitrator is selected to come up with a solution.

Other possible options include small claims court or a class action lawsuit.

If you sue — for medical costs, lost wages, etc. — in a small claims court, you may not need an attorney. In fact, in many such courts, attorneys are not allowed to represent clients. Each court sets a limit on how much a plaintiff can sue for.

If a number of current or former workers have all been injured by the same or similar conduct (or lack of it) by an employer or other party, they may get together with an attorney to file a class action lawsuit.

Due to the need for discovery (uncovering evidence, interviews, etc.) and the backlog of cases in most courts, either option may take many months or even years to complete.

How an Attorney with Workers’ Compensation Experience Can Help You
Your employer, their insurance company and their attorneys may have been involved in Workers’ Compensation cases for years. If you have never been involved in a Workers’ Compensation case, it would be unwise to go up against them alone.
You should have an experienced law firm on your side.

Your initial consultation, by phone, is free and without obligation. Its purpose is to help determine if you are eligible for Workers’ Compensation benefits and, if so, how the law firm can assist you.

On Workers’ Compensation cases, your law firm will be paid on a contingency basis, with the attorney receiving a specified percentage of the award if your case is successful, or no fee at all if it is not.

What to Do Right Now In Order To Claim Your Workers’ Compensation Benefits
First-time claims are often denied because the claim form was not complete and/or did not properly or adequately describe the injury or illness or the cause of death.

If you need help in filling out a Workers’ Compensation claim form—if you’d like to ensure that it states your case in the strongest possible terms and includes all the information needed—an attorney with relevant experience can help you get your claim resolved in the shortest possible time.

If your claim for benefits is contested—if the insurance company sends it back on a technicality or refutes your doctor’s or witnesses’ statements—an experienced attorney can help you revise it and strengthen it.

Or if your claim is denied by the Workers’ Compensation agency, but you are certain that you are entitled to benefits, an attorney may be able to revise it, strengthen it and resubmit it on appeal.

With thousands or tens of thousands of dollars at stake, you may need all the help you can get…especially if that help costs you nothing (except for expenses) unless you win.

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