People often get hurt while at work. They may receive a simple cut or deal with serious injuries after a slip and fall. Injuries happen in pretty much all workplaces, from construction sites to restaurants and offices. In 2019, private employers in the U.S. reported roughly 2.8 million nonfatal injuries and diseases acquired by their employees in the workplace. Too often, employees experience serious harm at work and require medical attention. Through a workers’ compensation claim, workers can get financial reimbursement for their work-related injuries. So, how do you file a workers’ compensation claim?
What Is Workers’ Compensation?When you experience an injury on the job, workers’ compensation helps you pay for related expenses. In exchange for this coverage, employees generally cannot sue their employers when they are injured on the job. Workers’ compensation tries to meet the needs of all parties involved. Under the law, most employers must purchase workers’ compensation insurance for their workers. Each state has its own set of compensation laws that detail which employers must purchase insurance, what must be covered, and how employees can file a claim after being injured. Most workers’ compensation insurance policies cover these injury-related expenses:
- Medical care;
- Permanent total disability;
- Temporary total disability; and
- Death benefits.
What Does Workers’ Compensation Cover?Nearly all employees who work for an employer can qualify for workers’ compensation if they experience one of the following injuries on the job:
- Physical harm. Bruises, cuts, burns, fractures, and other immediate injuries qualify as physical harm. If you experience a repetitive motion injury on the job, you may also qualify for compensation.
- Mental harm. Employees who experience mental or emotional harm related to a physical injury may pursue workers' comp, and in some limited circumstances when the employee experiences exclusively mental or emotional harm. Employees who develop the effects of brain hemorrhage are also generally covered.
- Occupational disease. Harm an employee develops due to exposure over time while on the job may cause an occupational illness. Infection, loss of hearing, dermatitis, and tuberculosis are common occupational illnesses.
- Accidental injury. A sudden or unexpected work-related activity may cause physical or mental harm. Accidental damage to artificial limbs and dental implants or devices also counts as injuries.
How to File a Workers’ Compensation Claim
The Process for Non-Disputed ClaimsThe first step of filing a claim is to alert the employer of a notice of injury. Workers should send the notice as soon as possible (ideally within 30 days) after the accident. The employer must then file a claim on the worker’s behalf with their workers’ compensation insurance company. Meanwhile, the worker should seek medical attention. The insurance company will collect a medical report on the injury or disease from either the worker’s doctor or the employer. A lack of medical information from a healthcare professional often leads to a delay in compensation. The insurance company may contact the worker for further details of the accident and the extent of the injury. If the worker and insurance company agree on the claim, the insurance company will begin to issue payments to the worker. An injured worker usually gets their first payment 15 days after the injury. Workers who do not receive their payments must contact their employer. Toward the end of the payment period, the insurance company will send the employee a notice of when the payments will stop.
Disputed ClaimsIn some cases, an employer or its insurer will dispute a worker’s claim of injury. They may put up obstacles to make it difficult for you to get the benefits you deserve. Their unwillingness to pay benefits may be due to a difference of opinion among witnesses or conflicting medical testimonies between doctors. Here are some tips for filing a successful workers’ compensation claim:
- Immediately alert your employer of an injury or disease. Keep checking to see if they have submitted an incident report.
- Seek medical treatment for the injury or disease. Discuss the rules regarding the level of treatment you may seek with your employer. If you don't think your employer is correct, consult a workers' compensation lawyer.
- Collect and keep all copies of accident reports and medical records. Relevant records include medical bills and reports on physical examinations.
- Meet with a workers’ compensation attorney as soon as possible.
- With the help of a lawyer, apply for a hearing in front of an Administrative Law Judge. Most parties get one hearing, and you will receive a notice of the hearing date 10 days beforehand.
- If needed, you can appeal for Commission Review. You need to file the appeal within 21 days of the Administrative Law Judge’s order.
- You can make further appeals to the Circuit Court. You have to file an appeal within 30 days with your attorney’s help.