Manual laborers have the largest number of injuries and illnesses than other industrial occupations. If you are in this industry or another that commonly has injuries, you need to understand how workers’ compensation claims work just in case.
Use this guide to understand a workman’s comp claim.
How to File a Workers’ Comp Claim
An injured employee can receive workers’ compensation benefits if they correctly file a claim. The claim must be filed before the state deadline. Next, let’s review the steps to follow to file a workers’ comp claim.
Reporting the Injury to the Employer
The injury must be work-related to receive a worker’s comp claim. Typically, these claims don’t cover stress, self-inflicted injuries, injuries caused by fighting, injuries from commuting to work, or injuries that occurred while committing a crime.
Once the employee has reported the injury, they should be sent to the hospital if it is an emergency. For nonemergencies, employees should still visit their doctor.
Getting the Right Paperwork
The necessary paperwork is needed to file a workman’s’ comp claim. Employers need to give the necessary paperwork to the employee so that they can file a worker’s comp claim.
The proper forms include:
- Insurance provider forms
- State workers’ comp board form
- Employer rights and workers’ comp benefits forms
- Form about returning to work
Filing the Claim
Normally, the employer will be the one to file the claim. This claim will be submitted to the insurance carrier along with a doctor’s medical report.
Approval or Denial of the Claim
After the claim is filed, the insurer will decide to approve or deny the claim. If the claim gets approved, the insurance company will call the employee to discuss payment.
Once this step has been taken, the rest is up to the employee and the insurance company. An approved claim will allow the employee to accept the payment offer or negotiate a larger settlement.
A denied claim means the insurer does not think the claim qualifies for benefits. If this happens, the employee can ask the insurer to review the decision or they can appeal it.
Going Back to Work
After filing worker’s comp claims, the employee needs to notify the employer and insurance about when they can come back to work. This means they have recovered sufficiently. If the employee experiences more injuries, the premium from the worker’s comp can increase.
Now that you know how to file a workers’ comp claim, there are other things you need to understand. Here are 10 tips for workers’ compensation claims:
1. Report the Injury Immediately
After an injury, an employee needs to immediately report it to their boss. Check your state’s deadlines to find out when you are required to give notice of injury. Missing the deadlines could cause you to lose the right to get a worker’s comp claim.
2. Get Medical Treatment Immediately
Medical treatment is an important part of getting worker’s comp benefits. A medical report by the doctor is a detrimental part of filing a worker’s comp claim. The medical report will document the accident by explaining the injuries and physical restrictions.
Getting immediate medical treatment can also help an employee recover quicker. A delay in medical attention could be an argument as to why your claim should be denied. The insurance company could say the injury was not as serious as it was claimed to be.
3. Consider Switching Doctors
Depending on the state, an employee may be treated by a doctor chosen by the insurance company. This could cause a conflict of interest because they get paid by the insurance company.
If you think you won’t get the right treatment with the doctor that is chosen for you, consider changing your doctor. The rules about changing your doctor will depend on the state you are in. Be sure to check out the regulations so you can switch your doctor in time.
4. Understand Available Benefits
A workman’s comp claim can provide you with benefits through the system. Each state will have its own rules about eligibility. Usually, the benefits available include:
- Temporary disability benefits
- Permanent disability benefits
- Medical treatment
- Vocational rehabilitation
5. Prepare for Independent Medical Examinations
A doctor hired by the insurance company will not focus on the injuries that need to be treated. They will perform an examination, review medical records, and give a report.
Prepare for these medical examinations by reviewing your medical history and getting ready for any questions asked.
6. Beware of Private Investigators
The insurance company could question your injury and hire someone to follow you. Footage that these people may get of you can be misinterpreted and used against you. Be sure to beware of any surveillance after filing a worker’s comp.
7. Keep Records
When you receive the necessary paperwork, it’s important to keep a copy for your records. Keep all of the medical records too because they may not be placed in your medical history.
8. Appeal Benefits Denial
The insurance company will try it’s best not to pay a worker’s comp benefit to save money. A reasonable workman’s comp claim can be denied because of this. If appealed, you have a good chance of receiving some benefits after being denied the first time.
9. Attend Every Appointment
You have to attend all worker’s comp legal meetings and appointments. If you are absent, you have a better chance of getting denied.
10. Consider a Lawyer
For extreme workers’ comp claims, you should consider hiring a lawyer. An experienced workers’ comp lawyer can help if the insurance company reduces or denies benefits, makes a settlement offer or ignores the claim.
A lawyer will help you navigate through the system because it can be difficult to do on your own, especially if the insurance company gives you a hard time.
Workman’s Comp Claim Explained
Understanding a workman’s comp claim can be rough. The insurance company doesn’t always make it easy. Use this guide to get the benefits you deserve after a work-related injury.
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