Personal Injury Workers Compensation Claims: What You Should Know

Personal Injury Workers Compensation Claims: What You Should Know

What follows is some basic information about workers compensation and the best ways to file claims. If you are in doubt, contact a Palm Beach County workers compensation attorney who can provide legal advice specific to your case.

Definition

If injured at work or you become ill because of job related reasons and are unable to work, you may have to file for workers compensation. This is a form of insurance used to cover medical care, rehabilitation, and lost wages for the injured worker.

Filing a Claim

To be eligible to receive workers comp benefits, you will have to file a claim. In doing so, it’s important to follow company, state, and insurer guidelines and requirements carefully.

  1. You should get immediate medical attention for your job related injury. Your employer must be informed of your injury as soon as possible. This may be tricky because every state has its own procedures for processing, including time limits on notification of employers. In some cases, the limit is up to a month. In others, you may have only a few days. In another region, you could have two years from the day you realized you were sick or injured. A workers compensation attorney can advise you as to when paperwork and other deadlines must be met.
  2. Every employer should have claim forms on hand. If you decide to file a worker’s claim without an attorney’s guidance, fill out the proper paperwork and be sure to submit them before applicable deadlines. It’s important to fill them out correctly to reduce the chance of a denial or delaying the process.
  3. After you submit the paperwork to your employer, they are obligated to submit it to their insurance company. Some states may require you file the claim directly with the state’s workers comp agency. If your employer files it, be sure to confirm when they have submitted it and document the date and time of submittal.
  4. If there is no dispute from the employer or the insurance carrier regarding your claim, it should be approved.
  5. An adjuster from the insurance company will contact either the employer or yourself with requests for documentation. It is here where the process may get sticky. It is not unusual for an employer to fight the claim as they want to avoid an increase of their compensation insurance rates. As a result, they may use whatever leverage they can to stall or stop the process. It is imperative that you produce sound documentation like medical bills, exams, and other records of your injury, sickness, and treatment.
  6. If you are not losing income, you are probably only looking at reimbursement of medical bills. If you cannot work, you should receive checks to cover most of your lost wages. The latter usually happens within two weeks of the claim’s approval. When you return to work, your employer will inform the insurance company to stop sending checks.

Trust that while this sounds simple enough, it likely will not be. The process can seem to move slowly. Your employer or insurer may reject your claim, forcing you to take action such as refuting the rejection. This may require hiring a lawyer and taking the matter to court.

Are There Incidents Not Covered by Workers Compensation Benefits?

While workers compensation covers certain debilitating diseases and illnesses, this insurance was specifically designed to cover injuries that happen on the job. The range of situations and injuries are generally broad, but there are limits insofar as coverage. Some states will test the accident victim for substance abuse to establish if the employee was under the influence at the time of the injury. If they are able to prove that, compensation will be denied.

Compensation can also be rejected if injuries were self-inflicted or if the employee violated a law or policy at the time of the injury. Another issue can be if the injury occurred when the employee was not physically on the job at the time of the injury.

An experienced workers compensation lawyer will be familiar with all applicable laws and regulations. Unfortunately, all too often a valid claim requires the assistance of an attorney in order that the victim receives the compensation they are due. Most workers comp lawyers offer a free consultation after which they can advise you on how best to proceed.


FKThanks to our friends and contributors from the Law Offices of Franks, Koenig & Neuwelt for their insight into the workers compensation claims.

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