Workers Compensation Claim Process

When you are injured on the job, you need to apply for workers’ compensation. Workers compensation settlements are designed to provide you with reimbursement for medical bills and lost wages. It is designed to support you while you can’t work or to pay benefits to your spouse or family in the event that a work related injury caused your death.

In most states, workers compensation state laws contain exclusive remedy provisions. This means that your only remedy is to file workmans comp settlements. You may not sue your employer for injuries. Therefore, it is essential to understand how to file a workers compensation report to protect your ability to recover for job related injuries.

Filing a Worker’s Compensation Claim

Worker’s compensation laws are administered by the state, which means the exact procedures vary on a state-to-state basis. However, there are many similarities and steps required in each state, in order to file a claim and get a workers compensation quote. The typical steps of a workers compensation claim are as follows:

1. Report Your Injury to Your Employer in Time

The amount of time you have to report your workers compensation injuries varies depending both on the state and on the type of injury. Some states require you to report your injury to your employer “as soon as is practical.” Other states require you to report your injury within 30, 60 or 90 days. Some states give you more then 1 year to report your work comp injury. In most cases, this injury report must be in writing.

If your injury does not have a specific start date- such as carpal tunnel- or if your injury is an illness that developed as a result of on-the-job exposure to chemicals, then the statute of limitations begins running form the time when you should reasonably have known about the illness or injury. 

If the injury resulted in death, the statute of limitations for family members to file a claim may vary. Furthermore, if the injury caused the employer to be incapacitated or mentally unable to file a claim, the statute of limitations may also be extended.

2. Visit a Doctor for Appropriate Exams

In some states, doctors must be certified by the Worker’s Compensation Board. However, you are always entitled to choose your own physician. The doctor should carefully document all the details related to your injury. You should keep detailed records of medical expenses that may be reimbursed as part of a worker’s compensation claim

If you are unable to work due to the injury, you may be entitled to short term or long term disability. Your doctor may have to examine you and make recommendations that relate to whether you are allowed to work. This can be a special type of exam that involves testing the level of disability or the functional competencies that were affected by your injury. Again, your doctor will need to document all recommendations, including restrictions from work.

3. Fill Out Required forms and/or File a Workers Compensation Claim

When you report your injury to your employer, they will usually give you employee injury report forms to fill out regarding the nature of the injury.  In many cases, when you submit these forms to your employer, the forms go directly to the worker’s compensation insurer. The insurer can then use these forms to determine what, if any, benefits you are entitled to.

You may also file a formal written claim with the worker’s compensation insurer. An attorney can help you file this claim to maximize the chances of the claim being accepted.

These forms and claim documents may require you to submit proof of injury in the form of medical records and other expert statements. The insurer may also require you to submit to a workers compensation independent medical examination. This exam is not intended as a second opinion for you, but is intended to verify the extent or cause of your disability.

4. Receive Notification from the Insurer

The insurer will send you a written letter explaining what, if any, benefits you will receive. This letter may accept your claim, or accept a part of your claim. It may deny all or a part of your claim.

If the letter denies benefits, it will explain the appropriate steps necessary to appeal the denial of benefits. If even partial benefits are denied, you may want to file an appeal to ensure full recovery of your damages. You usually have a stated time frame in which to file an appeal. If you do not file an appeal within this time frame, you lose the opportunity to file an appeal.

5. File Appeals if Necessary

Each state has its own procedure for appealing a denial of worker’s compensation benefits. In most state’s, this process is handled by a workers compensation appeals board. You will appear before the agency and testify, providing expert witnesses to support your case. It is strongly recommended that you bring an attorney experienced in worker’s compensation denials to all appeals, as in most cases this appeal is your last chance to recover for your injury.

Once the administrative agency has made a decision, you are bound by that decision in the vast majority of cases. If the board was egregiously biased or unfair or you suspect misconduct, in some states there are procedures available for judicial review. These reviews are for misconduct only and will not overturn a denial of benefits in most cases.

Finding Legal Help

Filing a worker’s compensation claim can be more complex then a standard personal injury lawsuit in many cases, due to the specific rules related to worker’s compensation cases. You should consult with an experienced job-injury attorney as soon as possible to maximize your chances of recovering damages for your job related injury.

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