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 while at work, seek first aid or medical care immediately as needed from any physician of your choosing. Also, notify your supervisor, employer, or office about the injury as soon as possible. You must provide notice in writing of your injury or work-related illness within thirty days. You can use the Report of Occupational Injury or Illness form (form 07-6101) to provide written notice of your injury. Complete your part of the form and provide your employer with all copies. After your employer fills out the form, your employer should provide you with the yellow copy.
Make sure to keep detailed records on hand while pursuing your claim. This will include having proper documentation of your earnings and earnings statements (W-2), information about your employer (address, name of supervisor, co-workers who may have seen your accident), information about your employer's insurance provider, and all relevant medical records related to the treatment of your injury.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
You employer should have workers compensation insurance and should post information related to the insurance coverage plan your employer participates in or self-insurance plan in three different places at your place of employment that are readily accessible. If your employer does not have insurance or refuses to provide you with information about the insurance program, contact the Division's Special Investigations Unit.
If your employer agrees to pay benefits, get the agreement in writing. If your employer refuses, file a workers' compensation claim against your employer. This claim will be forwarded to the Workers' Compensation Benefit Guaranty Fund, which works to provide compensation to employees whose employers were uninsured at the time of their injury. The fund will pay for your benefits and seek recovery from your employer so long as the employer is found responsible for your benefits and fails to pay.
Typically, the insurance provider will examine the circumstances surrounding your injury, review information regarding your employment history at the place of work where you were injured and will calculate your weekly disability compensation rate. The insurer must make a decision to either pay you benefits or deny you benefits within twenty-one (21) days of learning of your injury.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
Generally, compensation is payable only to those injuries which arise out of and occur during the course of your employment. Your benefits are not payable if the injury 1) was proximately caused by your willful intent to injure or kill any person or 2) proximately caused due to you being intoxicated or under the influence of illegal drugs.
4. What benefits might I be eligible to receive?
There are four types of compensatory benefits you may be qualified to receive: disability and impairment benefits, death benefits, medical benefits, and reemployment benefits.
There are three kinds of disability benefits and one kind of impairment benefit: temporary total disability benefits, temporary partial disability benefits, permanent partial impairment benefits, and permanent total disability benefits.
In the event of a work related death, the insurer will pay up to $10,000 for your funeral expenses and $5,000 to your spouse/dependents. Also, your dependents will be paid weekly.
Your employer is required to pay medical benefits up to two years following your injury, unless otherwise ordered. Medical expenses will be reviewed and held to the standard of what is necessary, customary, and reasonable. These benefits will typically cover doctor and nurse's fees, prescribed medicines, treatment costs, medical supplies and appliances, and reasonable transportation costs.
Re-employment benefits are assessed on an individual case basis, depending on whether you have not been able to return to work for a consecutive number of days. The reemployment benefits office will work with you to determine what kinds of assistance you need depending on the number of consecutive days you have been absent from your work as a result of your injury.
If your claim results in some form of compensatory benefit, you should expect to receive a check every two weeks. The amount of money you will be entitled to receive will depend on your gross weekly earnings, which is calculated based on a number of different factors. You can expect to receive about eighty percent (80%) of your gross spendable weekly wages, which are your gross weekly earnings minus any pay roll deductions. You may refer to the different rate tables to get an idea of what you may expect to be paid.
Be aware that your compensation will be confined within certain maximum and minimum limits. Your insurer may not pay you in excess of 120% of your weekly compensation rate and less than twenty-two percent (22%) of your maximum weekly compensation rate.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
You must report your injury in writing to your employer or the Workers' Compensation Division within thirty (30) days of your injury. Otherwise, your benefits may be barred unless the Division excuses you for failing to adhere to the time limit.
If your insurer denies you benefits, you must file a Workers' Compensation Claim within two years of the date you learned about your disability and its connection to your place of work.
The claims process will typically involve notifying your employer of your injury, working with your employer's insurance provider to determine whether your injury qualifies you for compensatory benefits, and depending on the outcome of the determination (whether your insurance has chosen to award to deny you benefits), you may choose to appeal to the Division by filings a Workers' Compensation Claim.
6. If I am not happy with the determination, how do I appeal?
If your insurer denies you the right to benefits, you must request a hearing with the Alaska Division of Workers Compensation Board within two years of the denial. This process begins with filing a written claim to the Board called a Workers Compensation Claim and begins a formal action against your employer's insurer for benefits. You may also file a claim if the insurer voluntarily began paying and then terminated disability payments.
You may choose to appoint counsel at any point in the process, from the time you are first injured and throughout the time you are entitled to disability pay.
The Adjudications Section of the Alaska Division of Workers' Compensation provides a mediation program for disputed claims that is accessible to all parties involved in a specific claim to succeed in issue resolution. Should any legal disputes or claims continue to be unresolved, a three-member panel of the Adjudication Section is composed to help resolve any issues. This panel works to enforce compliance with the state's Workers' Compensation Act, insure proper benefits are provided, and that employers provide workers' compensation insurance coverage to employees.