If you think you’re eligible for a worker’s compensation claim and are in the process of finding a work injury lawyer to represent you, there’s a lot you need to know about your case that will affect your eligibility for reimbursement.
The process of filing a worker’s compensation, including the documentation and approval process, is covered below, as well as information on understanding your injury and the process you need to initiate to be compensated for damages you’ve sustained on the job.
So first, what is a worker’s compensation claim?
If you or someone you know is injured on the job or develops an illness as a result of this job (such as mesothelioma resulting from asbestos exposure, for instance), they are most likely eligible for worker’s compensation.
This claim compares the damages sustained during the accident with the business insurance policy held by the employee. To cash in on the benefits afforded to you by this policy, you need to file the right forms under the right conditions.
If done correctly, an approved worker’s compensation claim can grant you money for lost wages, coverage of your medical expenses, or other industry-specific benefits. Since there are several parties involved, each with their own legal interests (these could include you, your employer, the insurer, the healthcare company, and the state’s worker’s board), the process can be complicated.
What is NOT covered by a worker’s compensation claim?
Most of what could happen to you on a worksite is covered by your employee insurance. This includes injuries sustained through exposure to chemicals, working with company equipment, or accidents on company property.
However, it’s important to note what will not be covered by a worker’s compensation claim so that you don’t pursue a legal avenue that ultimately won’t help you.
There are a few exceptions to the rule that injuries sustained on company property are covered by these claims. If it’s proven that your injury was caused in a self-inflicted incident or one that was instigated by fighting or playing around, for instance, then you will not be eligible to be reimbursed for your injuries. This also applies to ongoing psychiatric issues related to stress or any aspect of your mental health.
Injuries sustained while commuting to your job also don’t apply to worker’s compensation (unless, of course, commuting is part of your job, such as in a catering or trucking business). Injuries that result from repetitive activities like back issues for movers or carpal tunnel syndrome for typists present a bit of a legal challenge.
These cases are up to your company’s and insurance provider’s discretion.
Finally, if you are accused of committing a crime or suspected to be under the influence of alcohol or drugs while this accident or injury occurred, your worker’s compensation claim won’t be approved.
This applies not only to illegal activities on company property but also to your negligence of company policy. If you have been trained or advised by the company to do things one way and you sustain injuries doing them another, your claim will not be approved.
Also keep in mind that as an independent contractor, you would not be eligible for any workman’s compensation if you sustained an injury on your client’s property. You would have to be an official employee of that company to make such a claim.
How fast do I need to act?
Let’s say that you feel you’re in the right. You know that your injury sustained on company property was not your fault, in violation of company policy, or sustained while under the influence of any illegal or mind-altering substances. If so, how do you go about filing your claim?
It’s important to know this now since workmans’ compensation claims have a strict window of time after the injury occurred where you can file your case. You are only eligible for benefits for a few days, so you need to get on it.
You also need to know when the clock starts ticking on this limited window where your claim is still eligible. In the case of acute injuries or accidents, you only have a few days. The case of ongoing injuries like the mover’s bad back in the above example is a little more complicated.
The time limit for those claims is generally based on awareness: if your doctor told you that your back hurts because of your job or you take time off of your position because of your pain, that’s generally when the window opens to file a claim with your insurance provider or let it go.
So you may be wondering how much time you have, exactly. The limited window can be extenuating depending on the nature of the injury, the insurer’s policies, and the state in which this occurred. The real answer is: notify your employer as soon as possible and make your claim as soon as possible after that.
In Pennsylvania, for instance, most insurance company’s benefits start to expire 21 days after the injury was sustained. You may have limited rights to compensation even after that, but not the full extent of your policy. After 120 days, you may lose all ability to make a claim on this injury or receive benefits at all.
How do I file a Work Injury Claim?
If you know that your injury was sustained in a way that should be compensated by your insurance provider and that you’re in the limited window of time after the accident where compensation claims will be accepted, you need to know how to file your claim.
The first step in the claims process is to tell your employer that you’ve sustained an injury or become aware of an illness related to your job. You need to be able to tell them the time and date that the injury was sustained and how you were injured. After this, you will file a formal worker’s compensation claim with your insurance company.
Your employer will then submit an injury report to start the compensation process with the insurance company. If your employer doesn’t do this, there’s a three-year grace period where you can petition for your claim to be filed directly through your insurer. After this time, however, you will likely lose your right to your benefits.
Assuming the First Report of Injury is properly filed by your employer, it will go through a process of account statements, affirmations, notices of compensation, and stages of petitions. A workers’ compensation judge will review the case and secure or deny compensation based on the documents on file, the employee’s claim, and the insurance company’s policy.
To make sure that your claim has the best chance for approval, you need to know which steps to follow and in what order to form a successful case.
Your workers’ compensation claim schedule
To meet the appropriate deadlines that will give you the best possible chance of having your work injury lawyers successfully make your claim, you need to follow this schedule.
Notify your employer and file your claim
Within 21 days of your injury, you can report your injury to your employer to claim your insurance benefits. If you wait up to 120 days, you will instead only be able to claim benefits based on the date of your report, which can alter your compensation. After that time, you may not have any benefits at all.
Be sure to notify your employer as soon as possible that you’ve been injured on company property so that they can get the claims process rolling. You don’t want to miss out on your benefits.
Get a doctor
You need to see a doctor as soon as possible for a few reasons. One is liability: your employer and the company’s insurance provider will want documentative evidence of your injury and may even require you to see a company-designated doctor any time within 90 days of your injury.
However, the biggest reason is for your personal health. If you sustain an injury at work, you need proper diagnosis and treatment as soon as possible. Even though your claim is on your mind, your health should still be your priority.
File your claim
Your state has an office that will accept your claim (in Pennsylvania, for instance, it’s called the Pennsylvania Department of Labor and Industry). Your employer will file a First Report of Injury after you notify them, which will then be sent to the proper departments and the insurance company.
Get the proper forms
Your employer will submit the first report and then supplemental forms including notices of compensation to your state’s workers’ compensation bureau. If this process is not going forward, you may need to file a petition with your insurer or seek the advice of a work injury lawyer.
In most cases, worker’s compensation is your right. You have to know how your benefits work in order to get them, and also what can make you ineligible to be compensated for your injury.
By following these guidelines and meeting the right criteria, you should be able to file a successful claim. Seek the advice of a work injury attorney if you feel that you’ve been unfairly denied coverage or that your claim is being wrongfully delayed.