If you have been injured at work, you may be entitled to benefits under your employer’s Workers’ Compensation insurance policy. To find out for sure and to have a better understanding of your next steps, speak with an experienced workplace injury lawyer.
Workers’ Compensation Insurance
With few exceptions, every employer must carry Workers’ Compensation insurance. This is no-fault insurance coverage paid for exclusively by your employer to cover your losses if you are injured at work. If you deliberately injured yourself, you may not be eligible for benefits. However, if you contributed to your injury or were completely innocent of any negligence that may have caused your injury, you may be entitled to benefits.
Workers’ Compensation does not provide the same level of compensation for your injuries that filing a personal injury claim would. Workers’ Compensation insurance only covers your medical bills and lost wages for the time you are out of work recovering from your workplace injury.
To get benefits under your employer’s Workers’ Compensation policy, there are several steps you must take. Skipping a step or avoiding it altogether could result in your claim being denied and you missing out on the benefits for which you are entitled under your employer’s policy.
Reporting the Work Injury to Your Supervisor
The first step you must take is to report the injury to your supervisor. Most states have a short time limit of just a few days, up to one month. Your employer’s Workers’ Compensation policy may further limit the time you have to report, so it is best to let your supervisor know as soon as possible after you are injured.
Your employer needs to know that you were injured so they can file a report and begin collecting evidence of your injury for their insurance company, including speaking with any of your colleagues about what happened. The more time that passes between your injury and when you report it, the more skeptical the insurance company will be and the longer it may take for you to receive benefits.
Letting your supervisor know immediately after you get injured will also give you quick medical attention. This can be crucial to getting maximum benefits. When you are promptly treated and still have injuries, you have documented medical evidence from just moments after your workplace accident.
Filing a Workers’ Compensation Claim
After you have reported your workplace injury to your supervisor, you should be given forms to fill out. These forms will ask for details about your workplace injury, when it happened, and who was present. Your employer may file these forms with their Workers’ Compensation insurance company on your behalf, or you may have to file them yourself.
There is a deadline to file these forms, which will vary based on your employer’s policy details. Regardless of how much time you have to complete and file these forms, the sooner you get them in, the better. You cannot collect any benefits until your claim is approved, which can take a long time.
When filing your claim, you will need to provide details, documentation, medical records, and other evidence to support your claim. If you do not provide any of this information, the insurance company may deny your claim outright.
You will also need to file everything the insurance policy requests. There may be some related documentation they need, and if you do not provide it, they may again deny your claim.
After you have filed your claim and the insurance company has received all the documentation, they will conduct an investigation. During their investigation of your workplace accident, they are looking to see if there is a reason to deny your claim. If you intentionally injured yourself, that could be a legitimate reason for the insurance carrier to deny your claim. Regardless of their decision, they are required to tell you the result of the investigation, usually within one month after you have filed your claim.
If Your Claim Is Approved
In the best-case scenario, your claim is approved. Within a couple of weeks, you should start receiving your benefits. That could include reimbursement of any medical expenses you have paid up until that point and direct payment of any future medical expenses directly related to your workplace injury.
If you are going to be out of work for longer than one week, you may also receive partial pay. Although this may not fully replace your salary, it can help you support yourself financially while you are not receiving a full paycheck.
Appealing a Denial
The worst-case scenario would be that your claim is denied. Too many workplace accident injury victims take this denial as final. However, you can appeal.
Just like you had limited time to file your original claim, you have even less time to file an appeal. Therefore, you must act fast to understand why your claim was denied and what you can do to change that denial to an approval.
When the insurance company denies your Workers’ Compensation claim, they are required to tell you why. They cannot simply deny your claim without providing a reason. If your claim was denied because you did not submit relevant medical records, you can rectify that by getting the appropriate records and resubmitting your claim.
It is imperative that you make sure you address every reason for the denial, however, because this will be your last chance to get your Workers’ Compensation benefits. Like any insurance company, they are not looking out for your best interests and instead only looking out for their own profits. They will make every effort to deny your claim, so make certain that you provide them with everything they need to approve your claim.
Settling Your Workers’ Compensation Claim
If your injury is severe enough, it is entirely possible that your employer’s Workers’ Compensation insurance carrier will attempt to settle your claim. This can be a good thing, especially if you will be out of work for a long time, but remember that the insurance company is only looking out for themselves.
If the insurance company presents you with a settlement offer, take the time to review it and, better yet, have an experienced lawyer review it for you. Usually, when an insurance company makes a quick offer, they are trying to settle your claim for much less than what it is worth. If you sign the settlement agreement without considering whether it contains enough money for you to avoid paying out of pocket for your injuries, it will be too late. Once you sign the settlement offer, there is no going back.
Therefore, it is crucial to have a trusted legal advocate fighting to protect your rights and ensure you get the appropriate compensation and benefits. Your legal team can negotiate with the insurance company on your behalf and help you get the benefits for which you are entitled under your employer’s Workers’ Compensation policy.
How Do I Start a Workers’ Compensation Claim?
When you suffer an injury at work, it can be embarrassing, but also painful. Depending on the severity of your injury and the industry in which you work, your workplace injury could leave you without a paycheck for a long time. Most people assume industries such as construction are the most hazardous and result in the most frequent workplace injuries. Although those dangerous jobs do see higher rates of worker injuries, other jobs are not immune. Workplace injuries can just as easily occur to an office worker and can be no less severe.
ABOUT THE AUTHOR: Bryan J. Chant, Esq.
Bryan J. Chant is an experienced trial attorney vindicating the rights of injured people in Maryland’s courts. He is an alumnus of the William Mitchell College of Law, where he served as an Assistant Editor on the William Mitchell Law Review. His practice areas include personal injury and Workers’ Compensation.
Copyright LeViness, Tolzman & Hamilton, P.A.
Disclaimer: Every effort has been made to ensure the accuracy of this publication at the time it was written. It is not intended to provide legal advice or suggest a guaranteed outcome as individual situations will differ and the law may have changed since publication. Readers considering legal action should consult with an experienced lawyer to understand current laws and.how they may affect a case. For specific technical or legal advice on the information provided and related topics, please contact the author.