How To File For Workers Compensation Benefits
If you’ve suffered an on-the-job injury or developed an “occupational disease,” you may be entitled to workers compensation, also known as workman’s compensation or workers’ comp. Filing workers compensation claim is a tedious process, you should seek the help of an attorney to know how to file for workers compensation benefits online.
Filing a workers compensation claim is a complicated and tedious process. Don’t try to navigate this system alone. An experienced workers’ comp claim lawyer in your area can guide you through the entire claim filing process and advocate on your behalf for maximum compensation.
Workers compensation is a state-regulated insurance program that provides medical and income replacement benefits to employees injured in the course and scope of their employment. It may also cover vocational rehabilitation, temporary and long-term disability, and death benefits. In exchange for these guaranteed benefits, you give up the right to sue your employer for damages.
Every state except Texas requires employers to carry workers’ compensation coverage, but each has its own set of laws and stipulations regarding which types of workers are eligible, the amount of coverage offered, procedures and deadlines for filing a claim , whether you can choose your own doctor, and more.
Even if you are entitled to workers comp claim benefits, it’s not uncommon for employers and insurance companies to deny claims, delay payment of wage loss benefits, and offer a lowball workers comp settlement. Workers comp claim insurance adjusters are unfortunately focused on their bottom line and not the health of an injured party and will attempt to prove that your injury is not work-related or isn’t as serious as you claim it is.
To level the playing field, you need a qualified workers comp claim attorney in your corner who will fiercely protect your rights and advocate for a settlement you deserve. An attorney can explain the laws in your state and guide you through the claims process. They also know how insurance companies operate and will make sure you are not taken advantage of. You shouldn’t have to worry about your ability to support your family, you should be focused on your recovery.
A workers compensation lawyer can communicate with your employer’s insurer on your behalf, gather the necessary evidence to strengthen your claim, represent you at a workers comp claim hearing, and negotiate for the maximum amount to which you are entitled. In addition, they can make sure you receive the medical treatment you need and aren’t forced back to work before you are ready.
Recovering Compensation After a Workplace Accident
Workers compensation generally pays the following benefits…
*Please note that each state has slightly different set of guidelines and regulations for the approval of these benefits.
Medical Expenses: medical treatment that is recommended by your physician, and necessary for treating your illness or injury.
- hospital costs, emergency room
- diagnostic tests (MRI’s, CT Scans, ultrasounds)
- prescription medication
- dental care
- medical devices like prosthetics, crutches, and wheelchairs
- transportation to and from medical treatment centers
Temporary Income Replacement: If your doctor authorizes you off of work for more than seven days, you will receive compensation for lost wages or temporary total disability payments.
This is typically 66 percent (two-thirds) of your gross average weekly wage. The length of time for receiving these partial wage payments is determined by the type of injury and extent of medical treatment required. In addition, the duration is set by each state’s maximum pay-out period regulations.
Vocational Rehabilitation: If you’re unable to return to your previous job because of medical restrictions, you may be able to take advantage of vocational rehabilitation benefits which can provide tuition reimbursement or training to prepare you for a new job.
You will generally receive medical treatment until you’ve either recovered or until your doctor believes you have reached maximal medical improvement (MMI) which means you’ve reached your “plateau” in your medical condition or improved as much as you’re going to improve. At that point, your doctor or the workers comp claim board in your state will determine if you have any remaining impairment and if so, will rate your disability as a number or percentage representing how disabled you are.
This impairment rating is then used to establish how many weeks of disability payments you will receive at a fixed rate or indefinitely.
- Permanent Partial Disability: your impairment is permanent but only partially impacts your ability to work
- Permanent Total Disability: you are unable to ever work again. Many state laws provide a lifetime benefit while some states limit the benefits to retirement age and other states establish a fixed limit for payment of benefits, such as 750 or 1,000 weeks.
Death: If your family member was killed as a result of a workplace injury or illness, you may be entitled to receive death benefits. Most states provide funeral and burial costs.
Negotiating A Settlement
Many states allow injured workers to negotiate with the insurance company for a lump sum payment or to structure a settlement that is paid out over time instead of receiving weekly benefit payments. A lump sum settlement is paid now and covers future payments that the insurance company would be required to make.
Deciding to settle your case is something you should carefully consider with an attorney.
When you have reached your maximal medical improvement and received an impairment rating, your workers’ comp claim lawyer can begin settlement negotiations on your behalf with your insurance company. To calculate the true value of your claim, your lawyer will factor in the following:
- the extent of your injuries and your resulting functional limitations
- your disability rating
- whether the disability is partial or total
- whether the disability is temporary or permanent
- A number of your previous wages, and
- the costs of current and future medical treatment.
Common Causes of Workplace Injuries
- Forklift accidents
- Falls from heights
- Material handling
- Struck by or colliding with an object
- Incidents involving tools
- Malfunctioning work equipment
- car accidents
- Slips, trips, and falls
- Cumulative trauma
Common Injuries Resulting in Workers Comp Claim
- Back, neck and shoulder
- Spinal cord injuries
- Amputated fingers or loss of other body parts
- Eye injury
- Broken bones
- Leg, knee, and ankle injuries
- Carpal tunnel syndrome
- Cuts and bruises
- Head injury from falling objects
- blood clots
- skin conditions
Steps to Building a Strong Workers Comp Claim
Every state differs in the specific procedures for filing a workers compensation claim, but here is a general overview of what steps need to be taken to build a strong case
Report injury to your employer within the statutory deadline
The first step in filing a workers compensation claim is to report your accident to your supervisor or someone in a managerial position. Your employer should then fill out the first report of injury form and give you a copy. If there is no form, you will want to write out a statement detailing exactly when and where the incident occurred and what happened. Then sign and date it, make a copy, and give one to your supervisor.
Every state has a mandatory deadline for notifying an employer of a workplace injury or illness. If you fail to report your injury during the specified time frame, you may lose your right to receive benefits. Do not hesitate to inform your employer because you are embarrassed or fear that it will jeopardize your employment. Your employer cannot retaliate against you for exercising your right to be compensated.
Once notification has been made to the employer, the employer should submit the report to their insurance carrier. The employer’s insurer will then send the Employer’s First Report of Injury to the Division of Workers’ Compensation in your state.
Get medical attention
Regardless of the type of injury you have, it’s important to get evaluated by a medical professional. This ensures that you, a.) get a diagnosis and the medical treatment that you need, and b.) your injuries are properly documented.
It’s critical to give a complete and accurate description of how your injury occurred, and your complaints and symptoms since the injury. It’s also important that you continue to seek the medical care you need, attend all your appointments with your doctor, and follow all instructions regarding treatment and recovery. Failure to do so puts you at a disadvantage and gives the insurance company a reason to claim that you may not be as injured as you say you are. Having a detailed medical report is the most important step when you look for how to file for workers compensation claim.
Your employer’s insurer most likely has a list of pre-authorized physicians specifically for workman’s comp claims. As a result, the insurer will select the physician who will be authorized to treat you. This exam is usually called an Independent Medical Examination (IME), but it is not necessarily independent. These “independent” doctors are paid large amounts of money to downplay your injuries and to minimize the medical care costs that the insurance carrier has to pay out.
It is in your best interests to speak with a workers’ compensation attorney before an IME exam. He/she can advise you of your rights, as well as explain what to expect, when you are looking for details on how to file for workers compensation claims.
After you’ve been evaluated by a physician approved by your employer, you may request a second opinion or seek an independent opinion from a doctor of your own choosing. You may even be able to request a change of physician. If the insurance carrier refuses to let you change your physician, you may be able to work with your lawyer to petition the Industrial Commission in your state to let you change doctors.
Keep records of expenses related to your treatment, this includes: medical bills, mileage to and from all health care visits, physical therapy bills, prescription costs, chiropractor or massage bills, pay stubs,
Mistakes To Avoid
When you are looking for how to file for workers compensation claim, you should avoid the following mistakes.
- Don’t give a recorded statement to the insurance adjuster without a lawyer present.
- Don’t talk to your co-workers about your injury
- Don’t attempt to settle your case on your own.
Workers’ Comp Hearing or Trial
If your claim is denied or if you do not receive the benefits you believe you are entitled to, you have the right to request a hearing before the Workers Compensation Commission in your state. An Administrative law judge will hear the evidence and decide whether the decision should be upheld