How to File for Workers' Compensation Benefits

Learn the steps you need to follow to get workers' compensation for a workplace injury.

If you're injured or become sick on the job, you might be entitled to workers' comp benefits such as medical costs and lost wages. Insurance companies often contest workers' comp claims, so while some workers' comp cases are straightforward, many are lengthy and complex.

To ensure that you receive your benefits, you'll need to follow your state's rules for reporting your injury, filing a claim, and, if your claim is denied, appealing the insurance company's decision.

Get the Medical Care You Need

Your first priority, of course, should be getting the medical care you need. Be sure to explain to your doctor how you got hurt, including the fact that your injury or illness happened at work or during a work-related activity. Insurance companies are likely to deny your claim if your initial medical records don't adequately describe the accident and injury.

Report the Injury to Your Employer

As soon as you can, tell your supervisor about the injury and ask for the form to make a written report. You could lose your right to workers' comp benefits if you don't make a report within your state's required time period. Deadlines for reporting vary widely by state, but most states require you to report your injury or illness to your employer within 30 days or less of the date it occurred. In some states, the reporting period is as short as three or four days, so be sure to check with your state's workers' compensation agency to avoid missing the deadline.

Regardless of how long you have, it's a good idea to report your injury as soon as possible, as your employer's insurance company will likely be more skeptical of your claim the longer you wait to report it. Reporting your injury sooner also means you'll start receiving any benefits earlier.

File a Claim for Benefits

In addition to reporting your injury to your employer, most states also require you or your employer to file a claim with your state workers' comp agency. The deadline to file a claim is usually about one to three years after your injury.

The insurance company then conducts an investigation to determine whether to approve or deny your claim. Most states require the insurance company to tell you what it decided within two to four weeks.

Attend Your Medical Appointments

Make sure to attend all your medical appointments. Failure to do so will give your employer's insurance company an opportunity to argue that your injury isn't severe or you are fully healed.

If the workers' comp insurer disagrees with a decision by your treating doctor about your medical treatment, the insurer usually has the right to demand that you be evaluated by a doctor of its choice. This is called an Independent Medical Examination (IME). The purpose of the IME is not to treat your injuries, but to resolve questions about your medical condition.

If you have an IME in your case, make sure to provide the doctor with detailed background related to your injury, including an explanation of how it occurred, what your symptoms are, your treatment so far, and your relevant medical history. The doctor's report can be crucial to the outcome of your case.

Appeal a Workers' Comp Denial

If the insurance company denies your workers' comp claim, you have the right to file an appeal. As with your initial claim, you'll need to comply with your state's requirements for filing the right forms and meeting the applicable deadlines.

Appealing a workers' comp decision can be complicated and time-consuming. It often involves several legal proceedings, including a mediation or settlement conference and a formal hearing. Although it's possible to get through the process on your own, hiring an experienced workers' comp attorney to represent you during your appeal can greatly improve your odds of success.

Consult with a Workers' Comp Lawyer

A workers' comp attorney can make all the difference in a challenging workers' comp case. An experienced lawyer can gather the evidence needed to support your claim, deal with the insurance company on your behalf, help you navigate your appeal, and prepare you for depositions and hearings, among other things.

Hiring a workers' comp lawyer won't cost you anything out of pocket. In most states, workers' comp attorneys don't charge a fee unless you win your case.

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