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?
You should notify your employer as soon as possible about any injuries or illnesses that occur while on the job. Aim to notify your employer in writing no later than thirty (30) days after injury or you may risk losing an opportunity to file a workers' compensation claim. You should consult with your employer, if possible, about seeking the appropriate medical treatment. Your employer should furnish all medical expenses pending review of your case by the employer's insurance provider or by the worker's compensation board.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
The law requires most employers have workers' compensation insurance, in which employer and employee are expected to comply with procurement of benefits related to personal injury, death, or illness that arise out of the course of employment. If your employer does not partake in a workers' compensation coverage plan, he must have a certificate authorizing him to carry out business with the risk of no insurance. This means the employer will accept liability for a workers'compensation claim that may arise.
Your employer is required by law to place a notice informing employees they are covered by workers' compensation coverage. The notice must detail the name and contact information of either the insurance provider or the party responsible for administering the workers' compensation claims on behalf of the employer.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
Complying with deadlines, time frames, and application procedures will help to best ensure you will receive benefits in a workers' compensation claim. However, there are certain situations that may prevent you from obtaining workers' compensation. An employee who is injured as a result of self-infliction, intoxication, commission of an offense, failure to comply with safety protocol, or follow company policy. Generally, employees working as casual laborers, farmers, household employees, independent contractors, and certain state and/or government employees may be exempt from filing workers' compensation claims with the division.
Your employer's insurance provider should make a determination about the liability of your employer and your ability to receive compensation within thirty (30) days of notification of injury. If your claim is denied or no determination has been made, contact the workers' compensation board. Although, the insurance provider may request an additional grant of thirty days to make a determination from the worker' compensation board. Any determination about your claim, whether initial or subsequent, must be provided to you in writing.
4. What benefits might I be eligible to receive?
- Medical: You employer is responsible for compensating you for expenses incurred while seeking all reasonable medical care and treatment related to your injury.
- Rehabilitative: Services and opportunities provided to you, the injured employee, to help you get back to work or gain employment.
- Income: If you are unable to return to work for more than seven days, you will be able to claim weekly income benefits. If you are temporarily totally disabled and are unable to return to work, you will receive roughly two-thirds of your weekly wage, as determined by the amount you have earned over the previous fifty-two (52) weeks.
- Benefits to dependents: If death is a result of injury and/or work related illness within 500 weeks of injury, your dependents may receive up to 67% of your weekly wages for a period of 500 weeks. Your employer will be expected to pay for burial and funeral expenses should the circumstances permit.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
You should aim to notify your employer about your injury within thirty (30) days of the accident to help ensure that you will receive benefits. Your employer's insurance provider will likely be the authority to make the determination whether you are entitled to benefits. If your employer's insurance provider makes the determination that you are not capable of receiving benefits, you should find out why the claim was denied.
If a dispute ensues, you may contact the state ombudsman division to learn about potential resolution options. If none of these options seem applicable to your situation or helpful in handling the disputes, you should file an Application for Adjustment with the Workers Compensation Board. You have two (2) years from the date of your injury to file an Application for Adjustment.
6. If I am not happy with the determination, how do I appeal?
An award and determination by the Workers' Compensation Board will be considered final and conclusive in regards to all questions of fact. However, either party may appeal procedural errors to the state court of appeals within thirty (30) days of the board's judgment. The appeal will be governed by the rules of the court.
You are not required to obtain an attorney, however consulting with one may be to your advantage.