This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured at work, you must: 1) immediately report the injury to your supervisor, boss, or employer and 2) check with your supervisor or employer about which doctor you should see to examine your work related injury.
To properly file a claim, you must notify your employer with the details of your accident and subsequent injury, and make an application to your employer to receive benefits. You must notify your employer within five (5) days of your accident. Should your employer choose to accept any potential liability for your injury, your employer, your employer's insurance carrier, or a third party administrator should complete a WC Form 2 9/2006 form , also known as the First Report of Injury Form.
If you employer declines to accept any liability or pursue your claim on your behalf, you may call the Workers' Compensation Division to speak with an Examiner about your options. You are also entitled to obtain an attorney to handle your claim, should you seek to pursue the claim in court.
Be prompt in reporting your injury and communicating with your employer about filing a claim. You have two years from the date of your accident to file a verified complaint in the courts. Otherwise, you may lose your right to claim benefits for your injury.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Under Alabama Workers' Compensation law, if your employer employs more than four employees, full or part-time, your employer is required to have workers' compensation insurance coverage.
If your employer has coverage, you are guaranteed a "benefit certain" in the event of an on-the-job injury or occupational disease. However because your employer is guaranteed an "exclusive remedy" under provisions of law, it means you are limited to benefits required by law and therefore, your employer's liability is also limited.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
The following conditions must exist in order for you to be entitled to workers compensation benefits under state law:
- Employee must work for an employer who is covered by law. Generally the law covers employers of five or more employees.
- The injury must result from an accident, an unexpected or unforeseen event happening suddenly or violently with or without human fault that causes injury to the human body.
- The accident must be related to your employment. The accident must occur within the period of your employment, at a place you may reasonably expected to be within the scope of your employment, and while engaged in or fulfilling a duty of your employment.
- Prompt and informative notice of the accident and the injury should be given to your employer.
Certain circumstances may also prevent you from claiming benefits under state law. They include:
- The accident was caused by your willful misconduct.
- The accident was caused by the act of a third person or fellow employee for personal reasons, unrelated to your employment.
- You intended to bring about the injury or death to yourself or to another.
- You were intoxicated or under the influence of illegal drugs.
- You failed or refused to use proper safety mechanisms provided by your employer.
- You failed to or refused to perform a statutory duty.
- You breached a reasonable rule or regulation of your employer that you knew about.
4. What benefits might I be eligible to receive?
Generally, there is a three-day waiting period before your disability or benefits pay will begin. Your disability period starts on the fourth day you are out of work. Your benefits should be paid within thirty days of when it is due. (Code of Alabama, 1975 §25-5-51).
The types of benefits you may be eligible for will depend on the success of your claim and the nature of the injury you have suffered. Under Alabama law, most benefits qualify as compensatory benefits, medical benefits, or death benefits.
Compensatory benefits compensate you for wages lost as a result of occupational injury or disease. They are organized into four categories: temporary partial, temporary total, permanent partial, and permanent total.
In most cases for injuries, you would multiply your average weekly earnings for the year prior to your injury by two-third (66.67%). You can refer to the State's Average Weekly Wage chart to calculate an estimate of your benefits.
Medical benefits will include the costs of any reasonably necessary treatments for your injury. This will include related medical treatment, medicine, surgeries, supplies, artificial members, and other medical supplies.
In the event of death, your benefits will be distributed in different ways depending on whether you have dependents. If at death you have no dependents, your employer will pay $7,500 to your estate within sixty days of your death. If you claim one dependent, your benefits will be calculated based on your average weekly earnings prior to your death and multiplied by fifty percent (50%). If you claim two or more dependent, you average weekly earnings will be multiplied by two-thirds (66.67%).
Your benefits, whether resulting in injury or at death, cannot be less than the minimum compensation in effect at the time of your injury. Also, you claim will be subject to a limited time period. Depending on the type of claim, different time periods will apply. See here to learn more.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
You have two (2) years from the time of your injury to file your claim. However, failing to report your injury promptly to your employer may cause you to forfeit your entitlement to certain benefits. You should aim to report your injury to employer within five (5) days of your injury and no compensation will be payable if written notice is not provided within ninety (90) days.
After you notify your employer and your employer files the First Report of Injury, your employer will work with his insurance provider (if your employer meets the criteria for mandatory coverage, or if your employer participates in an insurance coverage plan) or the Alabama Workers' Compensation Division to determine if you are capable of receiving any benefits for your injury.
Your settlement of benefits should be calculated based on the formulas related to the category of benefits your injury qualifies you under; this may be medical benefits, compensatory benefits, or death benefits. If your settlement is for less than the authorized amount, the Alabama Circuit Court in the county with the appropriate jurisdiction will need to approve it.
6. If I am not happy with the determination, how do I appeal?
You, your employer, or your beneficiaries have a right to settle workers' compensation claims. If a settlement is not reached, either party may file suit in the Alabama Circuit Court in the county with the appropriate jurisdiction. A judge will handle most issues that arise in court; however you may request a jury to try issues of willful misconduct by your employer.
If your injury occurred after January 1, 1993, an ombudsman may mediate your claim and conduct benefit review conferences on your behalf. You are not required to participate in the Ombudsman Program; however, they are highly recommended.