What is Workers’ Compensation?
Workers’ compensation is a type of insurance that offers cash benefits or medical care for those who have faced occupational injuries and illnesses. Workers’ compensation pays benefits, pays for any necessary medical expenses as a result of your injury and illness, gives compensation if you’ve lost time from work, and provides disability benefits if you’ve faced a permanent disability as a result of your injury or illness.
Typically, workers’ compensation covers anything from sprains to burns. The most common injuries involved in workers’ compensation claims are muscle sprains and strains, lacerations, burns, eye injuries, fractures, and continuous trauma.
Steps to Take After a Workplace Injury
If you’ve faced a work-related injury, it’s important to first seek immediate medical attention: your health should be your top priority. After you’ve gotten your injuries treated, it’s crucial that you notify your employer of your injury. As an injured employee, be sure to give your employer a summary of the events before and after the injury, as well as the names of any fellow employees who witnessed the injury take place. In order to ensure occupational safety going forward, it’s important your employer knows exactly how your injury occurred so they can resolve any safety hazards at the workplace.
You can report your injury to your employer by filling out a “Report of Job Injury or Illness” form, which should be provided by your employer. You must also report your injury to your workers’ compensation insurance carrier, so you can begin the claims process. Without doing so right away, it will become much harder to get your claim approved later.
Filing a Workers’ Compensation Claim
Start the filing process by filling out form 801, “Report of Job Injury or Illness,” and giving this form to your employer to pass on to your insurance carrier. As an injured employee, you have legal rights to complete these forms and make claims against your employer. If your employer does not send this form to your insurer within five days, you can send it to your insurer yourself. If you see a doctor for your injury, they must fill out form 827, “Worker’s and Physician’s Report for Workers’ Compensation Claims.”
The most common mistakes involving filling out a workplace injury claim are failing to record injury and treatment, not reporting the accident to your employer right away, and not documenting the exact details of your injury. In order to make your claim stronger, it’s crucial that you keep track of medical records from your treatment and record the details of your injury, reporting them to your employer as soon as you can.
Required Forms and Documentation
To file a workers’ compensation claim, the most important form to fill out is form 801, “Report of Job Injury or Illness.” If you see a doctor for your injuries, you and your doctor will need to additionally fill out form 827, “Worker’s and Physician’s Report for Workers’ Compensation Claims.” It’s vital that you fill out these documents with accurate details and provide them as documentation of your injury when your claim is completed. Without proper documentation and evidence to support your claim, it will be more difficult to get your claim approved.
Common Mistakes to Avoid When Filling Out a Claim
In order to fill out your claim accurately, be sure to include as many details about the injury as you can remember. Also, consider including details about the impact the injury had, including loss of work time and other long lasting effects. These tips will ensure your claim is complete before you submit it, giving you the best chance at having your claim approved.
Common errors such as providing inaccurate and incomplete information surrounding your injury can lead to your claim being denied. To avoid this, keep in mind that your claims must be accurate before submitting all forms.
What to Expect During the Claims Process
From the day your employer is notified of your claim, your insurance carrier has sixty days to either accept or deny your claim. You’ll be notified through writing about whether your claim was accepted or denied. If your claim is approved, the settlement process can take from 12-18 months, including negotiations over the amount of compensation you will receive.
After you file your claim, the insurer will begin the investigation process. This includes taking a statement from both the injured employee and any relevant witnesses that can provide information relating to your injury. At this point, a medical professional will also be appointed to your case to preform any necessary medical examinations to validate that your injuries are accurate.
Investigation of the Claim
Your insurance carrier will take a statement from you and any other relevant witnesses. A doctor will also be chosen by your insurer to confirm your claims. This is typically done as a precaution to ensure your testimony is accurate before providing benefits. It’s important to have a lawyer who will ensure your claim is investigated fairly, so if you believe the doctor appointed by your insurer is biased, your lawyer will fight for you.
Medical Exams for Workers’ Compensation
During the workers’ compensation claims process, you may need to undergo a medical exam called an IME. An IME is an Independent Medical Exam in which a doctor preforms an evaluation to confirm your medical condition. This doctor will review your medical records and write a report, which carries significant weight in court.
To prepare for an IME, you must be ready to explain your injury truthfully, and thoroughly but briefly. You may also want to confer with you lawyer both before and after your exam to ensure your exam was conducted fairly. If you disagree with the findings of the IME or believe it was conducted unfairly, your lawyer can attempt to dispute the report and file a new claim with the Workers’ Compensation Appeals Board.
Appealing a Denied Claim
If your claim is denied, you will be notified of your legal rights for the appeals process. A denial does not mean you have to give up. In fact, in the paperwork notifying you that your claim was denied, insurers will often include the reason for the denial. If the reason was simply a mistake in paperwork, it may be possible to contact your claims adjuster to resolve the problem and get your claim approved.
If your case was denied for a reason other than mistaken paperwork, you will have to go through the appeals process. This process starts with a hearing before an administrative law judge, where you will need to provide medical evidence to support your claims. During the appeals process, it is even more important that you have an attorney in order to increase your chances at a successful appeal. It’s also important that you pay close attention to deadlines. You do not want to lose your injury benefits simply because you missed a deadline, so noting the dates for your hearings is crucial if you want a successful appeal.
Options for Appealing a Denied Workers’ Compensation Claim
The options for reconsideration are first to simply reach out to the appeals team and ask if the denial was a result of a clerical misunderstanding or error. This should be your first option as it does not require any additional hearings. However, if there is a different reason for your denial, you will need to file an appeal. This will result in hearings to validate or deny your claims. This option has a high likelihood of resulting in an approved claim, but also takes more time to complete and has harsher deadlines.
Tips for Increasing the Chances of a Successful Appeal
If you disagree with the decision of your workers’ compensation claim, you do have the right to appeal the decision. Before deciding to appeal your denied claim, be sure to find out the reason for the denial and make a strategy with your lawyer for the appeals process.
In conclusion, after sustaining a workplace injury, it’s important that you promptly receive medical care and report your injury. Ensure all forms and documents during the claims process are filled out correctly and accurately, and seek legal advice if you encounter difficulties with the claims process.