Delaware Workers Compensation Claims: Eligibility, Filing and Appeals

Employers with at least one employee are required to carry worker’s compensation insurance to protect their employees. Farm workers and domestic employees who work in private homes are exempt, but employers have the option of purchasing coverage for these workers. If your employer is uninsured or underinsured and you are a covered employer, you can file a petition for benefits from the Office of Worker’s Compensation who will provide benefits due and attempt to recoup the cost from an employer.

Work Related Injuries

Employees are covered for injuries that occur on the employer's premises, or on premises controlled by employers if the employee’s presence is required at the location. Employees are also covered for injuries that occur whenever the employee is under the control of the employer or engaged in the employer’s business in any location necessary to conducting that business. 

Coverage is excluded for injuries that are caused by another employee as a result of a personal dispute. However, coverage is provided for injuries caused to State employees by third parties if the injury was the result of an action directed at the employee because of his official position.

The injury must be a covered injury. Covered personal injuries include violence to the bodies structure, disease or infection that results from occupational hazards, exposure to chemicals that cause harmful changes in “the human organism,” damage to the body or to a prosthetic appliance such as eyeglasses or artificial limbs.

Filing a Delaware Workers Compensation Claim

As soon as you are injured or diagnosed with a work related illness, notify your employer. You should complete a First Report of Occupational Injury or Disease within 10 days of your initial injury. This form is available from your employer or from the Office of Worker’s Compensation.  Failure to provide timely notification or to visit an authorized physician may result in an inability to recover damages for an injury.

If your doctor believes your disability will preclude you from working for three or more days, you must provide written notice of your temporary disability to your employer as well. In the event of a disability, you must also provide documentation to demonstrate your average weekly wages. This documentation can include W2’s or pay stubs.  Agreements for disability benefits and lost wages must be approved by the Office of Worker’s Compensation.

Denial of Workers Compensation

Failures to provide timely notification of disability or to undergo a timely medical exam are common causes for denials. Other reasons for denials include liability disputes and disputes about whether the injury arose out of the employment or while under the employer’s control.

Appealing a Delaware Workers Compensation Denial

If your employer or your employer’s insurer denies your workers compensation claim, you must file an application with the Office of Worker’s Compensation to request a hearing. The Industrial Accident Board will hear workers compensation denial cases, and make a final decision in a claim dispute. You must file all appeals within two years of the date the injury occurred or within one year of the diagnosis of a work related injury.

When an appeal is filed, a pretrial hearing is scheduled and the employee must submit a list of benefits sought and witnesses that will be presented. A medical witness must be presented at the hearing to testify to the disability. The hearing date is then assigned within 120 days of the initial notice of pretrial.

Collecting Delaware Workers Compensation Benefits

Delaware workers compensation law provides for medical benefits, disability benefits and death benefits. Employees are permitted to choose their own treating physician and submit claims for payment of medical bills. Death benefits constitute burial costs and payment of lost wages to dependents of the deceased worker.

Temporary disability payments are available if you miss three or more days of work. The amount paid is equal to 66 2/3 percent of your gross weekly wages, up to a state maximum.

Permanent disability benefits are also available and the type of loss and your gross wages determine the amount paid. A scheduled loss, involving a limb such as the arms, hands, fingers, toes, legs, feet, eyes or ears, has a different payment rate then a nonscheduled loss. 

Disfigurement benefits and job retraining costs may also be paid to covered employees in the event that an injury results in a permanent scar, burn or other disfigurement. The amount paid is determined by how severe the scar is.

Talk to a Delaware Workers Compensation Lawyer

The Delaware Department of Labor advises injured workers that workers compensation hearings can be complex. You are required to arrange for expert testimony, and the employer and insurer will be represented by a lawyer. A Delaware workers compensation attorney can assist you hiring the requisite experts and filing the required pre-hearing motions. An attorney may also be useful when filing a claim to minimize the potential for denial and disputes.

Delaware Workers Compensation Office Locations

Wilmington
Office of Workers' Compensation
P.O. Box 9954
Wilmington, DE 19809-9954
302-761-8200
Fax: 302-761-6601

Milford
24 N.W. Front Street
Suite 100
Milford, DE 19963
302-422-1392
Fax Number: 302-422-1137