Most people who get hurt or sick at work have the right to receive workers’ compensation benefits. However, obtaining the full amount of those benefits isn’t always straightforward. At a minimum, it requires filing a workers’ compensation claim.
The steps in filing a workers’ compensation claim vary from state to state. Here’s an overview of how the process generally works and how an experienced workers’ compensation lawyer can get you maximum benefits and other payments for your work-related injury or illness.
A Workers’ Compensation Overview
Workers’ compensation (or workers’ comp) is a type of no-fault insurance. It covers some of the costs of getting hurt or sick at work, regardless of how the injury or illness happened. Workers’ comp usually applies to everyone who works for an employer, including full and part-time workers, adults and minors, and undocumented workers. (El seguro de accidentes de trabajo le cubre aunque esté indocumentado.)
Every state has its own laws and regulations governing how the workers’ comp system functions within its borders. Most states require all or nearly all employers to purchase employee workers’ compensation insurance. It’s generally illegal for an employer to force workers to pay for workers’ compensation insurance.
The benefits offered by workers’ comp vary from state to state according to their laws and regulations.
But in general, workers’ comp benefits include:
- Payment for all reasonably necessary medical care to treat a work-related injury or illness
- Replacement of a portion of the income a worker loses due to being partially or entirely disabled (unable to work), either temporarily or permanently
- Job retraining and vocational rehabilitation services
- In the event of a fatal work-related injury or illness, death benefits that include replacement of a portion of the deceased worker’s income, and funeral and burial expenses
Workers’ comp is a limited compensation system that does not cover all costs of getting hurt or sick at work. For example, it does not pay for your pain and suffering or loss of independence. Nor does it cover many common financial impacts of suffering an injury or illness on the job, like the need to hire extra help around the house or with childcare or the loss of job opportunities while you’re sidelined.
Unfortunately, a state’s politics and economic profile also tend to influence how easy or difficult the law makes it to file a claim and begin receiving benefits and how generous those benefits are. Some states, in other words, are far more protective of injured and sick workers than others.
Notifying Your Employer of a Work-Related Injury or Illness
Regardless of which state you live in, it’s always necessary to notify your employer promptly that you’ve gotten hurt or sick in connection with doing your job. Most states give you a limited amount of time to do this—usually just a few days and no more than a few weeks.
In Nevada, for example, an employee should give notice within seven (7) days. The safest way to avoid missing a deadline is to notify your employer immediately after getting hurt or learning that you have a work-related illness.
In some states, you may have to fill out paperwork when you notify your employer of your injury or illness. For example, Nevada requires you to fill out Form C-1 (“Notice of Injury or Occupational Disease”) and return it to your employer. Failure to follow the steps for documenting your notification can lead to a delay or denial of your benefits.
Seeking Medical Care
It’s also your obligation to seek medical care immediately for your work-related injury or illness. Go directly to a hospital emergency room if needed (just don’t forget to notify your employer at the earliest opportunity). And even if it’s not an emergency, go to a doctor as soon as possible. Never wait to seek medical care for a work-related injury or illness. Ignoring or downplaying a job-related injury or illness puts you at risk of losing workers’ comp benefits.
Generally speaking, you can seek emergency care at any hospital, usually the one closest to you. But if it’s not an emergency and you have a choice of doctors to visit, you may need to ensure the doctor can treat you under workers’ comp. In some states, workers must seek care from a medical provider the state or their employer has pre-approved.
For example, Nevada’s approved Treating Panel of Physicians and Chiropractors must list the doctor you select. Workers’ comp may not pay your medical expenses if you seek care from an unapproved doctor.
Notifying Your Doctor that You Got Sick or Hurt at Work
In most states, it’s essential to inform your medical provider immediately that you’re seeking care for a work-related injury or illness. That’s because the provider usually has a duty to fill out paperwork documenting your health problem and care and to submit it to the workers’ compensation insurance company and (in some states) your employer.
That documentation usually serves to notify the workers’ comp carrier of the cost of your care and of the extent of any disability that may keep you out of work (which entitles you to income replacement benefits).
If you don’t notify your doctor that your injury or illness happened in connection with your job, it can complicate receiving your workers’ comp benefits. The doctor may end up billing you directly for the care. And the workers’ comp insurance company won’t know that you’ve suffered a disability entitling you to income benefits.
Filing Your Claim
The actions that constitute the actual filing of a workers’ compensation claim vary widely from state to state.
In some states, including Nevada, notifying your doctor that your injury or illness is work-related triggers the claim filing process. Once notified that your condition relates to your job, Nevada medical providers must ask you to fill out the top portion of Form C-4 (“Employee’s Claim for Compensation/Report of Initial Treatment”).
They then must fill out the rest of the form and submit it within three (3) days to their employer and the workers’ compensation insurance company. This constitutes the actual filing of your workers’ compensation claim in Nevada.
But that’s not how it works everywhere. In some parts of the country, claim filing happens when employers handle the actual filing of a claim by sending documentation of their employee’s injury and treatment to a workers’ compensation insurance company. In others, employees must themselves fill out and send documentation to the workers’ comp insurer and their employer. Connect with an experienced workers’ comp lawyer right away if you have any questions about how to file a claim in your state.
Receiving a Claim Decision
Workers’ compensation insurance companies generally must notify you promptly of their decision to approve or deny your claim. Every state sets a time limit for the insurance company to decide and send you written notice. In Nevada, it’s thirty (30) days from the date of your claim filing.
Practically speaking, you might find out that the medical portion of your claim has been approved simply by the insurance company paying for your care. But the written notice you receive from the workers’ comp insurer must spell that out clearly, including whether there’s any portion of your medical claim that the insurer refuses to pay.
It will also tell you whether your disability claim has been approved and, if so, how much you can expect to receive as an income replacement benefit and for how long those benefits will last. If the insurer approves your disability claim, you can expect payments to begin soon after receiving the decision.
Unfortunately, workers’ comp insurance companies may deny part or all of a worker’s claim. The insurer might, for example, refuse to pay for certain types of specialty medical treatment. Or they might dispute the existence, extent, or duration of a disability and refuse to pay income replacement benefits. When this happens, the written decision the worker receives from the insurer must explain the reasons for the denial. It must also explain the worker’s rights to appeal.
Appealing a Claim Denial
All states entitle workers to appeal the denial of a workers’ compensation claim. The process of appealing varies by state. Typically, state laws and regulations provide for several levels or stages of an appeal.
In Nevada, for example, you can first ask a hearing officer from the state’s Department of Administration to review the denial. If you disagree with Hearing Officer’s decision, you can ask for further review by an Appeal Officer. And if you disagree with that decision, you can seek still further review in Nevada state court.
No matter where you live, however, it’s almost always critical to have an experienced workers’ compensation lawyer represent you in the appeal process. Appealing a claim denial involves complicated legal procedures and doctrines. Making just one mistake at the beginning of the appeal process can lead to losing your rights to workers’ compensation benefits. Contact a knowledgeable lawyer immediately if you receive a claim denial to learn about your appeal rights.
Legal Options Outside of the Workers’ Compensation System
If you got hurt or sick on the job, you might have the right to receive compensation outside the workers’ compensation system.
Pursuing a personal injury lawsuit against someone whose wrongful decisions, actions, or inaction harmed you at work can secure you payments over and above your workers’ comp benefits for your:
- Medical and other expenses not covered by workers’ comp
- Lost income not covered by workers’ comp
- Pain and suffering
- Diminished quality of life
- Loss of independence
Talking to an experienced workers’ compensation attorney is the most reliable way to determine if you have the right to receive additional compensation. Deadlines may apply, so connect with a lawyer as soon as possible.
What a Workers’ Compensation Lawyer Can Do for You
A workers’ compensation lawyer can represent you at any stage of the claim filing process, from the first steps after you get hurt to appealing a claim denial.
Having a lawyer on your side has numerous benefits because a lawyer can:
- Investigate your injury or illness to identify its causes and parties who may have liability to you.
- Oversee preparation of any required paperwork to start the claim filing process.
- Make sure you meet all applicable deadlines for filing a claim.
- Advise you on which doctors you may consult for your injury or illness.
- Act as your representative in all workers’ compensation insurance company dealings.
- Respond to workers’ comp insurer requests for additional information about your claim.
- Ensure that your employer and the workers’ compensation carrier meet applicable deadlines and handle your claim in good faith.
- Handle the appeal of any claim denial.
- Prepare and pursue a lawsuit for additional compensation on your behalf (when applicable).
Most workers’ compensation lawyers offer a free, no-risk consultation for you to learn about your rights. They also represent clients on contingency, which means they only get paid if they deliver results for you. (Required disclaimer: You may have to pay an opposing party’s court fees and costs in the event of a loss.)
Contact an Experienced Workers’ Compensation Lawyer Today
If you or someone close to you suffered a work-related injury or illness, filing a workers’ compensation claim can get you some benefits to help cushion the blow. You may also seek additional compensation through a third party liability lawsuit.
Contact an experienced personal injury lawyer today for a free consultation about your options and learn what the lawyer can do for you.