Understanding the Workmans Comp Claim Process

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Workplace injuries happen each day, ranging from falls to broken bones and back pains. The risks leave numerous workers unable to do their jobs on a short-term or long-term basis. According to the U.S. Bureau of Labor Statistics, in 2019, there were around 888,000 non-fatal workplace injuries that caused private industry workers to miss at least a day of work.

This is where workers' compensation comes in. It's an insurance policy aimed at helping employees recover from work-related injuries or illnesses. However, for an injured employee to benefit from a workmans comp claim, you need to follow the proper compensation claim filing process and adhere to all requirements. Here is an informative guide to get you started.

What Is a Worker's Comp Claim?

An employer should pay for workers' compensation insurance to cover any employee accident or ailment caused by exposure to materials, machines, or other work activities. When an employee develops occupational illnesses or gets injured in the line of duty, they can lay claims and negotiate with an insurance company for compensation.

After approval, the injured worker receives lost wage replacement, medical bills, and other benefits. The insurance also benefits the employer since the compensation coverage keeps the business from being held liable for the expenses. It also protects a company from possible legal action should an employee sue them. However, it's worth noting that the workers' compensation claim doesn't cover:

  • Psychiatric disorders
  • Injuries caused while committing a crime or when under alcohol or drugs influence
  • Fighting injuries
  • Self-inflicted incidents
  • Accidents that occur while commuting to work

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Why File a Workmans Comp Claim?

Some employees question whether it's worth taking the steps involved to file a compensation claim. Well, it's a legal right, and you shouldn't hold back from seeking compensation. All you have to do is prove that you got injured or sick from work-related activities.

You will benefit from full medical treatments covering everything, including surgeries, X-rays, physical therapy, or diagnostic testing. You won't pay any bills or face deductibles.

Additionally, if you can't work when you're injured, you will receive monetary benefits as a wage replacement. In case you experience physical limitations, you will receive compensation for long-term injury after filing the claim.

The amount received depends on your lifestyle, occupation, and injury type. The insurance's main objective is to ensure that the injured employee and their families have a certain income level even after a disability or incapacity to work.

How to File a Workers Comp Claim

Sometimes, the workers comp claim process may feel overwhelming, especially if you don't have the proper knowledge of what it entails. Consider the following steps to better handle workers' comp claim forms and notices.

1. Get Immediate Medical Attention

The first step before filling the compensation claim form is to seek medical attention. Even if you feel that you don't need to see a doctor, it's a requirement in the workers comp claim process. Some insurance policies may require that you see a specific doctor, so it's a good idea that you confirm this with your supervisor first.

If you feel like you aren't getting proper medical attention from the chosen physician, you can change doctors, but confirm this with the insurer. Explain to your doctor about the injury in detail, and be sure to indicate that it's work-related.

If the doctor recommends that you don't work for a certain period or advises you to avoid certain activities, request the notes documenting the orders. You also need to follow the medical instructions precisely.

2. Inform Your Employer

You should report any injury that occurs at your workplace immediately to your supervisor. Notify your employer through writing for an official record. The employer should then create an accident report including all the details of the injury.

If the injury develops gradually, notify your employer as soon as symptoms appear so that you can receive medical care in time. Note that, in most states, you could lose your right to receiving compensation claim benefits if you report the injuries after 30 days.

3. Fill Out the Workers Comp Claim Form

Your employer will then give you an official claim form. Depending on the state you live in, you might also need to fill in a form to report the case to the state's workers' comp board. To fill out the workers' comp claim forms and notices, include your name, address, age, gender, marital status, hire dates, current position, and wage information. Also, specify the type of injury you sustained as well as the body part affected.

You also need to briefly explain how the accident happened. Mention any parties involved in the accident as well as the date, time, and location of it. Remember to also note if you have received any form of medical treatment.

4. The Employer Submits Official Paperwork

The next step on how to file a workers comp claim is submitting the official paperwork. Once you complete filling the forms, hand them over to your employer to send them to the insurance company. Your doctor may also need to mail your medical report to the insurer. Again, based on the state you're filing in, the employer needs to present the documents to the workers' compensation board regardless.

5. The Claim Approval or Denial

After receiving the paperwork, the insurance company evaluates everything and later notifies the employer whether they approve or disapprove your claim. Either way, the insurance company will have to inform the workers comp board of the settlement.

Be prepared for independent medical examinations. Some insurance companies may hire a doctor to review your medical records, examine your current situation and give a report. The insurer may also question your case's credibility and even investigate to see whether you do anything that contradicts your workers' comp claim.

For instance, if your medical report says that you can't carry heavy objects and a surveillance camera sees you moving big boxes into your house, the insurer has evidence to disapprove your claim since you are lying about your symptoms. The insurer may also deny your claim if you tell your supervisor a different story from what you say to the doctor about how the incident happened.

Mostly, the insurance company will let you know what they decide within two to four weeks. In some states, if the insurer fails to deny the claim within the deadline, it's automatically considered approved.

6. The Employee Gets Back to Work

As an employee, you will notify the insurance company and the employer when you fully recover and wish to get back to work. Based on the nature of your injury, you might continue enjoying some benefits from the insurer. If an employee continues to experience occupational injuries, the premium may increase.

An employer must ensure that they make necessary changes to help the injured employee do their job better. An employer can even choose to give you a different role that minimizes risks. The employer should also provide adequate training to ensure that staff members do their jobs safely and reduce injuries.

What Happens When You File a Workers Comp Claim?

If they approve the claim, the insurance company will notify you of the payment details and the benefits you are entitled to. You can choose to accept the payment offer or negotiate for a lump sum settlement. On the other hand, if the insurer finds your case invalid, they may deny your claim. At this point, you may need to stay in touch with your lawyer to guide you in the best possible cause of action. You can choose to ask the insurer to reevaluate the settlement or appeal.

Anytime you notice more problems from your injuries, write them down, inform your employer and insurer, and you might get compensated for these too. You should also keep all your receipts and ensure that you attend all legal proceedings concerning your case. If you fail to attend some legal appointments, you risk losing your workmans comp claim benefits. Your lawyer can represent you in some hearings, but you must be present during medical examinations and depositions.

Always remember that the insurance company watches all your moves to help them make a decision. Any photos on social media where you are involved in activities that could worsen your condition may affect your benefit. The insurer can also end the benefits if you fail to follow medication correctly or miss therapy.

Both the employer and employee must follow the right workers comp claim process to make a successful claim that guarantees better outcomes. Be completely honest about the injuries and provide the necessary records, and you will have your claim approved. When you face troubles with your worker compensation benefits, consult a professional to clear things up. If you have any questions, contact us for more information.

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