Alabama Workers Compensation Claims: Eligibility, Filing and Appeals

Employers with five or more employees are required to provide worker’s compensation insurance to employees. Employers can self-insure and pay claims themselves, or can provide benefits through a worker’s compensation insurer.  There is also an “assigned risk pool” available for employers denied traditional insurance.

Most employees within Alaska are covered. Exceptions include agricultural employees, farm workers, domestic employees, part time or casual employees, and town government employers if the area has a population of 2,000 people or less.

What is a Work Related Injury?

In order to be covered, an injury must arise from an accident that occurs “out of and in the course of the employment.” Accident is defined as an unforeseen or unexpected event that happens suddenly without fault. The accident must produce damage to the body. Out of and in the course of employment is defined as the requirement that there be a causal relationship between the job and the accident.

The injury must occur during working hours, anywhere where the employee could reasonably be as part of his job. The accident must also occur when the employee is fulfilling the actual duties of his job, or doing work incidental to fulfilling the duties of the job.

Alabama Workers Compensation Claim Filing Process

Employees must provide notice of their injury to their employer within five days of being injured. Formal written notice must be given within 90 days of the injury. If the employer has actual knowledge of the injury, written notice requirements may be waived.

When filing a claim, employees must file out WC Form 2 9/2006, which is the first report of the injury. This constitutes an initial claim for benefits. In most cases, WC Form 3 and WC Form 4 must also accompany the initial claim. Form 3 is a supplementary report providing additional details about the accident and injury. Form 4 is a summary of the claim.  Medical records, including doctor testimony, must be submitted with the initial claim for benefits.

Denial of Workers Compensation Claim

Claims may be denied for a number of reasons. Common reasons for denial include coverage questions regarding whether the injury arose out of the course of the job, and failure to submit appropriate evidence and documentation of the injury or extent of the disability.

Appealing an Alabama Workers Compensation Denial

If the insurer denies the initial claim for benefits, an employee can call the Workers Compensation Division and ask to speak with an examiner who will review the case. An examiner can make a decision on the insurers denial. The examiners decision can then be appealed to the Hearings and Appeals Division of the Department of Industrial Labor Relations.  The written appeal must be filed no later than 15 calendar days after the denial of benefits notification was mailed.

The employee can also file a claim in the Circuit Court, requesting judicial review of the denial of benefits.

Collecting State Workers Compensation Benefits

Medical benefits, death benefits and disability benefits are provided under Alaska worker’s compensation laws. Medical benefits include reimbursement for doctors’ visits, surgery and any other costs related to the injury. Death benefits include a burial allowance and survivors benefits.

Disability benefits include temporary total disability payments, permanent partial disability payments, and permanent total disability payments. Payments are based on a  percentage of the wages earned when disabled, as verified by pay stubs or W2 forms. Additional benefits are available for permanent disfigurement and/or job retraining.

Consult an Alabama Workers Compensation Lawyer

Workers compensation attorneys can be hired at any point in the claims process. Attorneys’ fees are paid as part of workers compensation benefits and cannot exceed 15% of the total amount of benefits paid or recovered in a worker’s compensation claim. Attorneys can help file initial claims and/or request review by examiner or file claims for judicial review of benefit denials.

Alabama Workers Compensation Office Locations

Department Of Industrial Relations Workers' Compensation Division
649 Monroe Street
Montgomery, Alabama 36131
334-242-2868
1-800-528-5166