Worker’s compensation is a no-fault insurance policy that most private employers in the U.S. must provide on behalf of their employees. When an employee suffers a work-related injury, they can file a claim against this policy to receive benefits such as wage replacement and the cost of medically treating the injury. While the process seems straightforward, several issues and delays can arise, often leaving claimants wondering how to check the status of their worker’s comp claim and how a worker's compensation lawyer can help.
The Process of Filling a Worker’s Compensation Claim
According to the U.S. Bureau of Labor Statistics, around 2.7 million nonfatal workplace injuries and illnesses happen yearly across the country, and nearly 1.2 million of these injuries result in at least one missed day from work.
While each state has a process for filing worker’s compensation claims and receiving benefits, the process generally includes the following steps:
- The injured worker seeks prompt medical treatment for their injury and reports the injury to the employer.
- The employer reports the injury to their worker’s compensation insurance policy provider.
- The insurance provider reports the injury to the state and evaluates the claim to determine if the worker is eligible for benefits.
- The insurance provider informs the worker of their benefits. Injured workers who incur lost time due to their injury often fall within the categories of temporarily, partially, or completely disabled. They only receive a portion of their lost wages until they can return to work in their full capacity or are deemed permanently disabled.
- The worker continues to obtain medical treatment for their injury. When they reach maximum medical improvement, a doctor determines their disability level. Compensation either continues until the worker reaches retirement age, they’ve been deemed healthy enough to perform the tasks of their job, or they can perform the tasks of a different job position.
The Classifications of Disability Used for Wage Replacement Benefits
For injured workers, the disability incurred falls into one of four categories to determine the wage replacement benefits owed.
These categories include:
- Temporary partial disability - Injuries that heal over time and can cause the injured worker to work on restricted hours or restricted duty during this healing period. Workers on temporary partial disability receive compensation for their reduction in wages due to work restrictions until they are healthy enough to return to full work responsibilities.
- Temporary total disability - Injuries that cause the employee to miss days from work but from which they will fully recover. Workers on temporary total disability must often miss a certain number of consecutive days to qualify for wage replacement benefits. For example, in Wisconsin, workers only receive compensation for wage loss after three consecutive days of missed work. However, if the disability lasts longer than seven calendar days, they will also receive compensation for the first three days.
- Permanent partial disability - Injuries from which the worker is unlikely to recover. However, a worker who is permanently partially disabled is still able to perform some standard work tasks to earn an income. This level of disability generally results in a lump sum or weekly payment of the difference between the average weekly wage of the worker before the injury and the average weekly earnings they can make after the injury.
- Permanent total disability - Permanent injuries that impair the worker’s ability to perform any job-related tasks.
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How to Check to See if Your Employer Has Coverage
While most private employers must provide worker’s compensation insurance, not all employers are compliant with the law, and some employers are exempt from it. Most states have a website that employees can use to determine if their employer has worker’s comp.
For example, in Minnesota, employees can use the online insurance lookup tool the state Department of Labor and Industry provides or call the department during regular business hours to inquire about an employer.
How to Check to See if Your Employer Has Reported Your Injury to Their Insurance Provider
When an injured worker reports their injury to their employer, the employer must promptly inform the insurance provider who carries their worker’s compensation policy. When the insurance provider receives the claim, they only have a certain time to decide on benefits. If you are not convinced that your employer reported the injury to the insurer, you can ask the employer directly or contact the insurance provider.
How to Check to See if the Insurance Provider Has Approved Your Claim
During the investigation of your claim, a claims adjuster from the insurance company will likely contact you. If some time has passed and you have not received correspondence from the insurance provider, you can contact the claims adjuster to inquire about the status of your claim.
How to Dispute a Worker’s Comp Claim Denial
Worker’s compensation is a no-fault insurance policy—meaning the worker does not need to prove that an employer or coworker’s negligence caused the injury. The worker must only prove that the injury occurred at the workplace or during the normal scope of their employment.
A policy provider may try to deny a worker’s compensation claim because:
- The worker did not seek prompt medical treatment for their injury or failed to inform their employer of the injury within a reasonable time.
- The employer does not believe the injury occurred at the workplace or thinks the worker’s symptoms resulted from a pre-existing condition.
- The injury occurred due to horseplay, or the employer believes the worker deliberately caused their injury to obtain benefits.
- There were no witnesses who saw the injury occur.
- The worker was intoxicated by drugs or alcohol when the injury occurred.
When an insurance provider decides to deny a claim, they must notify the claimant in writing and provide a reason for the denial. They will also include instructions on how to appeal the denial, which usually involves a hearing before the state’s worker’s compensation board.
If you are denied worker’s compensation benefits, you’re overwhelmed by the worker’s compensation process, or you want someone to handle your claim while you focus on your recovery, hire an experienced worker’s compensation attorney.
Need More Information About Your Claim? An Attorney Can Help You
Worker’s compensation attorneys often are personal injury attorneys with specific experience and interest in assisting injured workers in obtaining wage replacement, medical treatment, and other benefits to assist them as they recover from a workplace injury. While individuals can certainly obtain information about their claim by following the procedures listed above, an attorney can also provide answers about the status of your claim and other services to ensure you get the maximum amount of worker’s comp coverage available. Here is a look at some of the services a worker’s comp attorney can provide.
Ensuring You Have the Proper Documentation of Your Injury
Like other insurance claims adjusters, the insurance company hires workers’ compensation adjusters to cut costs. This strategy means they’re less concerned about ensuring you have the benefits you deserve and more concerned about keeping your claim as small as possible.
An experienced worker’s compensation attorney can ensure that you have the medical documentation needed to support your claim, making a benefit approval a more likely outcome.
Addressing Delays in Coverage
Workers’ compensation policies approve benefits for many individuals only to have an administrative error or other mishap delay their wage replacement payments or payment for medical treatment. If you experience a delay in receiving your benefits, your worker’s compensation attorney can determine the source of the delay and work to resolve the matter.
Negotiating a Settlement
Often, the issue with worker’s compensation benefits is not an outright denial but rather a refusal to provide enough coverage to meaningfully assist the worker while they recover from their injuries.
When a dispute arises, your attorney can fight for your right to the benefits you deserve by providing evidence and legal arguments to show:
- Your injuries are more serious than the insurance provider believes, and you cannot return to work.
- Your injuries are permanent and eligible for a higher disability classification.
- Your employer owes you past benefits that you did not receive because they previously denied your claim.
Assisting You in Obtaining Other Types of Benefits
In addition to wage replacement and medical coverage, most states offer additional workers' compensation benefits, depending on the injured worker's circumstances. For example, when a worker dies from a workplace accident, their family members may obtain reasonable expenses associated with a funeral service and burial or cremation, a portion of the deceased worker's average weekly income, and even educational assistance.
Your worker’s compensation attorney can assist you in obtaining these benefits and can also explore options for other benefit programs where you can receive additional assistance, such as Social Security Disability Insurance (SSDI).
Helping You With a Claim Dispute
While different states have their own appeals process for workers’ compensation claim denials, each process ultimately ends up either in an administrative hearing or a trial before the judge. These legal proceedings can be stressful for claimants. Still, an experienced worker’s compensation attorney can perform many litigation services, including deposing witnesses, preparing you for an independent medical exam, filing petitions and motions during the legal process, and arguing your case in court.
Studies Indicate That Providers Eventually Pay Most Denied Claims
According to a report in Engineering News-Record, employers in many industries—including construction and engineering—hold down costs by denying workers’ compensation claims. However, this is often not the wisest course of action, as the policy provider eventually approves most claims, increasing in value.
Research found that two of every three denied workers’ compensation claims pay out within a year. The average cost of the claims was slightly over $10,000 at the time of the study. However, the average cost of claims originally rejected and eventually paid was nearly $15,700.
The most obvious reason for the increase in the value of a worker’s comp claim after being denied is the legal costs associated with preparing to fight the claim in court and ultimately being responsible for the costs of the trial and the worker’s legal fees.
Another area in which worker’s comp claims increase after a denial is in medical costs in states where the insurance provider or employer is responsible for choosing a physician to treat the worker’s injuries.
Once a provider denies a claim in those states, the worker can seek treatment from the provider they choose, resulting in more expensive treatments. In Wisconsin, workers can choose their treating physician. Many workers can do this in Minnesota, as well, provided their employer isn’t participating in a certified managed care plan.
Want to learn more about the worker’s compensation claims process? Contact a personal injury attorney near you for a free case evaluation.