The Workers' Compensation Claim Process
Most employers are required to carry workers' compensation, or "workers' comp," insurance to cover employees who are injured on the job. Employees do not have to prove fault in order to recover, it is a "no-fault system." But benefits are not automatic.
Specifics of the workers' compensation claims process vary by state, but injured employees generally must notify their employer and the workers' comp carrier. Regardless of state laws, however, injured employees are always encouraged to obtain any necessary medical treatment first.
Assuming you've already received medical attention, the workers' compensation claim process involves several important steps. You must:
- Notify your employer in writing
- Fill out an official claim form (which should be provided by your employer)
- Keep detailed records about your treatment
The workers' comp claim process is discussed in greater detail below.
Get Immediate Medical Attention
Before filing a workers' comp claim, make sure you get the necessary medical treatment. Some workers' comp policies require injured employees to see a specified doctor, so you may want to ask your supervisor. But many state laws allow you to get a second opinion if you are not satisfied with the first one. Even if you don't feel the need to get medical attention, it may be a requirement for the workers' compensation claim process.
Keep in mind that a medical report will serve as an official record of your injuries and the basis for any workers' comp reimbursement.
Notify Your Employer
Make sure you notify your employer about the injury within the statutory deadline, preferably soon after the injury occurs. In New York and California, for example, an employee has 30 days in which to notify their employer about a job-related injury. It's a good idea to report all workplace accidents even if you don't suspect an injury, just in case an injury is discovered after the deadline expires.
As with any legal process, make sure you notify your supervisor in writing. Even if you give verbal notification first, a written follow-up notification will provide an official record. The sooner you do this, the more details you will be able to recall.
Your employer probably will give you an official claim form as part of the workers' compensation claim process. But if not, you should request one from the workers' compensation board of your state. Generally, you will need to provide the following information on your workers' comp claim form:
- Type of injury and affected areas of the body;
- Date, time, and location of injury;
- Parties involved in the accident;
- How the accident occurred; and
- Any medical treatment you have received
Workers' Comp Claim Process: Employers' Responsibilities
Most employers that are required by law to provide workers' comp coverage face the prospect of fines, criminal charges, and lawsuits if they fail to do so. Workers' comp regulations depend on the state and the number of employees. In general, employers cannot retaliate against a worker who claims workers' comp. Employers have strong incentives to comply with the law and complete all valid claims.
Usually, your employer will file your claim with its insurer and the state workers' comp board office. After your claim is evaluated by the insurer, an administrator will notify you about whether your claim has been accepted and the amount of benefits to which you are entitled.
After the Claim
Most of your involvement with the workers' compensation claim process is complete after filling out the necessary paperwork. But you still want to follow up on your claim and make sure you keep detailed records. For instance, you may want to keep a journal of how the injury affects your work and day-to-day activities. Also, be sure to keep receipts for out-of-pocket expenses and proof of any other hardships caused by the injury, including time lost from work
If your claim is rejected, you will have the opportunity to appeal in most cases.
Consider Getting Professional Legal Help With Your Workers' Comp Claim
Dealing with complicated legal matters can be very stressful for non-lawyers, especially after sustaining a work-related injury. The workers' compensation claim process is often uneventful but sometimes can require the delicate touch of an experienced legal professional. It's often in your best interests to meet with a workers' comp attorney before filing your claim.
You Don’t Have To Solve This on Your Own – Get a Lawyer’s Help
Meeting with a lawyer can help you understand your options and how to best protect your rights. Visit our attorney directory to find a lawyer near you who can help.
Contact a qualified workers' compensation attorney to make sure your rights are protected.