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The Workers' Compensation Claim Process

Most employers are required to carry workers' compensation, or "workers' comp," insurance to cover injured employees. Workers' compensation is a type of insurance that offers benefits to workers. It can help with medical bills, wage replacement, and more. It is like a safety net for the workplace and is an essential aspect of workers' compensation law.

Employees do not have to prove fault in order to recover. It is a "no-fault system." However, benefits are not automatic. Specifics of the workers' compensation claims process vary by state, but injured employees generally must notify their employer and the workers' comp carrier. Regardless of state laws, however, injured employees are always encouraged to obtain medical treatment first.

Assuming you have already received medical attention, the workers' compensation claim process involves several necessary steps. You must:

  • Notify your employer in writing
  • Fill out an official claim form (which should be provided by your employer)
  • Keep detailed records of your treatment

The workers' comp claim process is discussed in greater detail below.

Get Immediate Medical Attention

Before filing a workers' comp claim, get any necessary medical treatment. Some workers' comp policies require injured employees to see a specified doctor, so you should ask your supervisor. However, many state laws allow you to get a second opinion if unsatisfied with the first one. Even if you do not need medical attention, it may be a requirement for the workers' compensation claim process.

Remember that a medical report will be an official record of your injuries and the basis for any workers' comp reimbursement.

Notify Your Employer

Ensure you notify your employer about the injury within the statutory deadline, preferably soon after the injury occurs. For example, in New York and California, an employee has 30 days from date of injury to notify their employer about a job-related injury. It is a good idea to report all workplace accidents even if you do not suspect an injury, just in case an injury is discovered after the deadline expires.

As with any legal process, notify your supervisor in writing. Even if you give verbal notification first, a written follow-up notification will provide an official record. The sooner you do this, the more details you can recall.

Your employer probably will give you an official claim form as part of the workers' compensation claim process. If not, request one from your state's workers' compensation board. Generally, you will need to provide the following information on your workers' comp claim form:

  • Type of injury and affected areas of the body
  • Date, time, and location of injury
  • Parties involved in the accident
  • How the accident occurred, and
  • Any medical treatment you have received

This report is called the "first report of injury." It is essential to do this as quickly as possible, usually within a few days of the date of the injury.

Workers' Comp Claim Process: Employers' Responsibilities

Most employers that are required by law to provide workers' comp coverage face fines, criminal charges, and lawsuits if they fail to do so. Workers' comp regulations depend on the state and the number of employees. In general, employers cannot retaliate against workers who claim workers' comp. Employers are incentivized to comply with the law and complete all valid claims.

The employer then files a claim with their workers' compensation insurance carrier and the state workers' comp board office. This is the insurance company that provides workers' compensation insurance. This company will assign an adjuster to look at the claim. The adjuster's job is to figure out if the claim is valid. After the insurer evaluates your claim, an administrator will notify you about whether your claim has been accepted and the benefits you are entitled to.

The injured worker might need medical care. In that case, the insurance company can pay for their medical expenses. The medical provider (the doctor or hospital) will send the bills to the insurance company. The bills are sent to someone other than the worker. The medical provider will also keep medical records of the treatment.

Sometimes, the worker cannot return to work immediately or at all. This could be because of a permanent disability or a total disability. Disabilities can also be considered permanent partial. In these cases, the worker can get disability benefits. This is a wage replacement. This money helps make up for the wages the worker cannot earn. If the worker can return to work but cannot do the same job as before, they might need vocational training. This is training for a new job that workers can do despite their injury.

After the Claim

After a worker files a claim for workers' compensation benefits, a process begins to make sure the worker gets the help they need. If you have ever suffered a workplace injury or occupational disease, this is what might happen. Most of your involvement with the workers' compensation claim process is over after completing the necessary paperwork.

You still want to follow up on your claim and keep detailed records. For instance, journal how the injury affects your work and day-to-day activities. Also, keep receipts for out-of-pocket expenses and proof of any other hardships caused by the injury, including time lost from work.

If your claim is rejected, you will have the opportunity to appeal in most cases. If the worker disagrees with the insurance company about the benefits, the workers' compensation commission may step in. These groups help settle disagreements about workers' comp claims. The worker can ask for a hearing.

It can be tricky to handle this on your own. For this reason, many workers choose to get legal representation. A workers' comp lawyer can help workers understand their rights and navigate the system. They can explain medical benefits and wage loss. They can also help you with personal injury claims, if applicable.

Consider Getting Professional Legal Help With Your Workers' Comp Claim

Dealing with complicated legal matters can be stressful for non-lawyers, especially after sustaining a work-related injury. The workers' compensation claim process is often uneventful but sometimes can require the delicate touch of an experienced legal professional. Remember, the worker's compensation system is there to protect workers. It is based on the state's workers' compensation act, which is the law that makes sure employers provide insurance for their workers.

If you ever get hurt at work, remember you are not alone. You can contact a workers' compensation attorney to understand your rights and get your needed help. They can help explain workers' comp benefits and represent you against your workers' compensation insurance carrier if there are any disputes. A workers' compensation lawyer will provide you with valuable legal advice.

Meeting with a workers' comp attorney before filing your claim is often in your best interests.

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