Suffering an injury or illness on the job can be a stressful and overwhelming experience. You are not only hurt and trying to heal physically, but you also have to go through the claims process.
In a perfect world, it would be as simple as reporting the claim to your employer who then sends it to the insurance company. But the world isn’t perfect, and as an employee, it's crucial to understand the steps involved in filing a claim and getting your benefits.
Understanding the Fundamentals of Workers' Compensation
Workers' compensation is an insurance program that is overseen by the state. It is designed to provide financial support and medical care to employees who are hurt on the job or develop a job-related illness.
The program covers various conditions, from sudden accidents like slips and falls to gradual onset illnesses like repetitive strain injuries or occupational diseases. If you are injured, you will be able to receive medical care, payment of lost wages, and disability payments.
What should you do first after an injury?
The first thing you should do after being injured at work is figure out how quickly you need care.
If you require emergency treatment, that is your top priority. Go to the emergency room and worry about documenting your injury after.
Your medical records from the emergency visit will help you document the incident once you are medically able to do so.
As soon as you are able, you need to set the steps in motion to get your accident documented:
- Notify your immediate supervisor or HR department
- Document all the details surrounding the incident
- If applicable, gather witness statements
- Keep a detailed list of medical expenses
Each state has a set time for reporting work-related injuries. Make sure you report your accident as soon as you can. Failure to do so may affect your ability to collect.
Where should you go for medical help?
When you are injured on the job, you must seek medical attention from the appropriate healthcare provider. Check with your employer and find out if their policy has specifics on doctors. Your employer may have approved providers, or you may be able to use your doctors.
It is important that you keep all appointments and follow your treatment plan closely. If the employer’s insurance policy specifically requests an independent evaluation, make sure you follow through.
Filing a Workers' Compensation Claim
To initiate your workers' comp claim, complete the required forms for your state and submit them to your employer and their insurance carrier. Your employer can give you the correct forms.
Be thorough and accurate in your documentation, as any missing or incorrect information could delay the processing of your claim. Each state has a statute of limitations for filing workers' comp claims, typically ranging from 5 to 30 days from the date of the incident or the discovery of your condition.
Your employer then submits the required documents to the insurance company. The insurance company reviews the documents, reviews your employer’s policy, and determines what the policy will pay. This part of the claims process may take more than a few days.
When can you return to work?
Once the claim has been accepted or denied, you and your employer should devise a plan for your return to work. This should be a team effort that includes your doctor's orders.
You may be required to return on limited work duty or given a full release to return to work. Your employer will normally be willing to work with you on your return, even in a limited capacity.
For work-related illnesses that appear over time
Some work-related conditions don’t appear immediately. Occupational illnesses such as those associated with healthcare may not be evident for many years.
These types of workers’ compensation claims can be difficult to navigate alone. They often require extensive documentation and expert testimony to establish the connection between your condition and employment.
If your case is too complex, you may want to seek outside help to settle your claim. Don’t feel like you are doing anything wrong; you deserve to be treated for your injuries.
Tying it all together
You need to understand the steps to filing a workers’ compensation claim as an employee. While you hope you never have to use the process, if you are hurt, you don’t have to hope you get medical treatment and compensation.
When you are hired, your employer will explain the steps for accidents and injuries. If not, ask.
Find out what to do before you need to know what to do. It’s your right as an employee to get medical treatment if you are hurt. Your employer maintains insurance specifically for accidents and injuries. Know the process and follow it.
Note: The information provided in this blog is intended for general informational purposes only and is not a substitute for professional legal or insurance advice. Laws and regulations regarding workers' compensation insurance are complex and vary by state and by specific circumstances. Therefore, readers are encouraged to consult with a qualified legal or insurance professional to obtain advice with respect to any particular issue or problem they might have.
Mordechai Kamenetsky, co-founder and lead agent of Kickstand, is recognized as an expert in workers' compensation. He is passionate about helping small businesses manage risks and lower their workers' comp costs. In his articles, he educates readers and clients on the intricacies of workers' comp insurance.
Most states require businesses to carry workers’ compensation insurance. These policies provide vital protection for employees injured on the job or through work-related duties or processes.
