Do you know how to file a worker's compensation claim the correct way?

How do you file for workers comp?

If you have been injured on the job, there are a few things you must-do if you want to correctly file a claim for assistance. There are many rules and regulations in place around claims, so they have to be done correctly and on time.

What is the exact process you have to go through?

After a workplace injury, a worker has a short time frame to fill out all of the forms if they want to get the compensation assistance. In many cases, after an injury, a lot is going on and you don’t always think to do a bunch of paperwork. That is why you have to know these essential steps now. Many claims are denied because the worker didn’t submit them when they should have, and they don’t end up getting any benefits.

After an accident, your employer has to initiate the process by providing you with the right forms and papers to fill out. They also legally have to tell you any processes that might be specific to your business, industry, or insurance policy. Beyond just sending in your forms to the insurance company, there are also laws and government regulations you must follow. Here are some of the things you absolutely must do:

Tell your employer in writing how exactly the incident took place, what injury you suffered because of it, and exactly what day and time it happened. From there you send it to the claim’s office of the insurance company. Each state has different rules so where you live has a big impact on the process you must follow.

In what situations can an employee submit a compensation claim?

An example of a situation where an employee can submit a compensation claim would be if they got injured while they were doing something related to work. Most people think this just means getting in an accident. However, it can also mean if you came down with a disease or illness because of exposure to chemicals or something similar.

Not all claims get accepted so they have to meet the following conditions:

1. Your company must have a compensation policy.
2. You have to be a full-time employee, that means that contractors, and 1099 don’t qualify.
3. The injury or illness you sustained occurred at work and because of work.

These would be examples of claims that would most likely be rejected for various reasons:

1. A majority of psychiatric cases aren’t covered by insurers.
2. If your injury was your fault or happened because of something you did to yourself.
3. Stress, although unhealthy, is not considered an injury.
4. If you got injured in a fight or from fooling around on the job, that wouldn’t be covered.
5. Commuting to and from the workplace don’t count either.
6. If you broke the law when you got hurt, that voids the claim automatically.
7. If there was evidence that you were under the influence of drugs or alcohol, that would prohibit your claim from being accepted too.
8. If when you got injured, you were violating a corporate rule or policy that would also mean your claim will likely get denied

The proper way to submit a compensation claim:

1. After suffering an injury, you inform your employer in writing.

Workers' compensation claims are only accepted if they are first verified by the employer to be related to work. This could include having something fall on you in a warehouse or maybe getting a lung infection from being exposed to something harmful on the job. If you are seriously hurt or have to go to the emergency room. They will be able to verify the industry. Or if it is less serious, you can receive a formal diagnosis and medical file from a physician or hospital. In many cases, not every doctor is a part of the insurance company’s network. Unfortunately, you might have to go back for another consultation or visit with a doctor that is.

The important thing is to have written documentation from a medical professional of the injury and to submit it to your employer and insurance company as soon after the event. As a general rule of thumb, send in your forms and tell your employer by 30 days. If you contract cancer or something that slowly develops, you still should report at the first sight of symptoms.

2. The employer provides the necessary paperwork to the employee

After you tell your employer, they must give you the right forms you need to fill out. These forms will be for the insurance company as well as the state board. They will also give you documentation on your rights as it pertains to workers' compensation as well as if or when you can be expected to return to work. Again, a lot of this depends on the state you are in as well as the type and the severity of the injury. In an ideal situation, your company will give you all of this even before you go for treatment on your injury. Hopefully, this information is available to you right now in your new hire packet. Your company has to give it to you one way or another. Otherwise, they are breaking the law.

3. The claim is filed

Even though you have to submit a bunch of paperwork to the insurance company, it is your employer who submits your claim to them, along with the medical professional attesting to the injury. The state board also gets copies of everything, so they keep track. This board tracks all injuries that happen in the workplace, despite if they are workers' compensation claims or not.

4. The claim is either approved or denied by the insurance company

There are a lot of different variables that go into a decision to accept or reject a claim. If they decided to accept the claim, they will contact you and tell you how they will pay you. If they reject the claim, they will reach out with less exciting news. The state board is also informed of the decision.

If you get denied you can always appeal with legal representation if necessary. If you are approved, you want to make sure that your medical bills, wages, payments and many other costs are covered as much as possible. No two settlements are the same.

5. The employee returns to work

When you go back to work will be determined by when you have recovered sufficiently. You will need to tell the insurer and your company in writing when this date will be. In some cases, you might still receive some benefits after you go back to work. It is also important you truthfully return to work when you feel able.