Workers compensation benefits are intended to provide wage replacement and necessary medical care to an injured or ill claimant whose condition is the result of employment. Each of the 50 states administers a separate workers comp system. The process required to file a workers comp claim differs slightly between states for that reason. However, the basic steps necessary to win the workers comp claim is substantially similar in each state.
Before preparing the workers comp case, you’ll need: the Notice of Claim; Notice of Appeal; and a copy of your Employer Report (in which the injured worker makes an immediate report to his or her supervisor after the injury or incident, usually presented as soon as possible or within 30 days of the accident or onset of illness).
Bureau of Workers Compensation
Take the following steps to file a workers compensation claim:
Step 1: Search for the state department that oversees workers comp claims in your state. The name of the workers compensation department is often called the <i>department</i> or <i>bureau of workers compensation.</i>
For example, Ohio, Pennsylvania, and Tennessee have a bureau of workers compensation. Search for <i>bureau of workers compensation</i> in a search engine toolbar to identify a complete list of state departments’ workers comp offices.
Each state administers its own workers comp program(s). Locating your state’s workers comp department and reading the workers comp rules for your state may make the difference between winning or losing your claim for workers comp benefits.
Step 2: File the official workers comp claim form. Your employer must provide you with the claim form(s) needed within 24 hours of providing notice of the accident, illness, or disability your doctor confirms is due to work-related events or conditions.
If your employer doesn’t have the workers comp claim form(s) you need, request them from your state’s bureau of workers compensation. Provide specific information on the form about your illness or disability. Before filing the original workers comp claim form, copy and retain your work.
Step 3: Document the illness or injury that is work-related. Ask for statements from individuals who witnessed the incident or accident who can provide testimony about your illness or medical condition.
Maintain a handwritten journal to include dates, symptoms, affected body parts or organ systems, level of pain, and treatment plans offered by your medical team.
Step 4: Visit a doctor or hospital and seek necessary medical treatment as soon as possible after a work-related accident or injury. If your employer requires you to see a doctor within the state workers comp system, you will probably need to do so. Depending on your state’s workers comp laws, you may have the right to a second opinion or independent medical evaluation.
Compliance with the medical team’s treatment recommendations is very important. Your failure to comply with doctors’ orders may result in a denial of the workers comp claim or loss of current workers comp benefits.
Step 5: Appeal the denial of workers comp benefits if this has occurred. If the first claim is denied, prepare a written Notice of Appeal within your state’s time limits.
Attach a copy of the letter of denial. The letter should include how much time you have to prepare and file an appeal and details about the procedure required to appeal the denial of workers comp benefits.
Step 6: When your appeal hearing is scheduled, it is important to carefully prepare for it. Contact witnesses before the hearing date if they plan to present testimony at the hearing. Make duplicate copies of documents and evidence, including medical records, laboratory results, doctor and hospital bills, and your journal as described in Step 3.
Workers Compensation Benefits Appeal
As soon as you’re injured, obtain a copy of local physicians and hospitals who accept workers comp patients. If you desire a second opinion, ask the state bureau of workers compensation about what other options are available.
You may not need to hire a workers compensation attorney but, if the claim for workers comp benefits is denied on the first round, or the claim content is complex, an experienced workers comp lawyer can provide insight throughout the process.