Filing a Workers’ Compensation Claim & the Legal Process
People who are dealing with an injury or illness on the job can pursue workers’ compensation benefits to cover their medical costs and provide partial wage replacement. This process involves meeting certain deadlines and requirements. The first priority is seeking medical care, which may involve emergency attention. If you do not need emergency care, you should look into the rules for receiving medical treatment under the workers’ compensation system in your state.
Workers may have as little as one week to report a work-related accident or illness.
Also, an injured worker will need to report the accident or illness to their employer within a certain time period. This varies by state, but a worker often needs to take action within 30 days or less. Sometimes the deadline may expire within a week. Even if your state has a longer deadline for reporting the injury or illness, you should try to report it as soon as you can. Long delays without an apparent cause may give rise to suspicions by your employer or the workers’ compensation insurer. Many workers’ compensation claims are denied, even for legitimate injuries, and any irregularity increases the risk of a denial. By contrast, promptly reporting your injury or illness can mean that you will start receiving benefits efficiently.
The Process of Filing a Claim
Your employer should be able to provide you with the paperwork that you need to file a claim. It may handle the process of submitting the paperwork on its own. If your claim is approved, you will not need to take any further action. However, some states require a claimant to file a workers’ compensation claim form with the workers’ compensation agency. This government agency must receive the form within a certain deadline, which may be different from the deadline for reporting the injury to the employer. A worker usually receives a longer time window for submitting the form, such as a year or even more.
In some rare situations, an employer will hinder an employee who is seeking workers’ compensation benefits. This happens most often when the employer is self-insured and responsible for paying benefits independently. You can contact the workers’ compensation office in your area to handle a recalcitrant employer.
An insurer usually has a certain time window in which it needs to decide whether to approve or deny an injured worker’s claim. It must provide the employee with notice of the decision. Failing to provide notice of a denial within the required time period may be considered automatic approval, although not every state applies this rule. If your claim is approved, you will receive benefits soon afterward.
As noted above, many deserving workers’ compensation claims are initially denied. You can pursue an appeal if you believe that the insurer wrongfully denied your claim. This process involves meeting additional deadlines, complying with specific procedural rules, and often gathering and presenting further evidence. A worker who needs to appeal a denial of a workers’ compensation claim may want to consult an attorney.