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?
To best ensure success in filing a workers' compensation claim, you must provide notice of your accident to your employer as soon as possible. The notice must describe the time, place, and specifics of the accidents and should include your name and address. You should provide notice to your employer within twenty (20) days of the accident. Failing to provide notice within the twenty (120) day period may not bar your claim completely; however, failing to provide notice within seventy-five (75) days after the accident will very likely bar your claim.
Your employer is responsible for filing a report with the director of the workers' compensation division concerning any accident that occurs during the course of employment to you or any other employee to which your employer has knowledge about. This report should be filed within twenty-eight (28) days of the knowledge of the accident.
Upon learning of your accident and/or injuries related to that accident, your employer may request that you seek a medical examination from a medical professional to determine the extent of your injuries and how to proceed with the claims process. Your employer will be liable to those fees related to requested examinations.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
If you are injured in an accident arising out of and the in the course of your employment, your employer is liable for the compensation benefits pursuant to you filing a workers' compensation claim.
Your employer is required to either 1) purchase/engage in a workers' compensation insurance coverage program or 2) become self-insured. Your employer must possess a self-insurer permit authorized by the workers' compensation division in order to qualify as self-insured. An employer who is not insured in either of the above manners will be liable to you, the injured employee, should a valid workers' compensation claim exist.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
You will not be able to seek workers' compensation benefits should your injury result from your own personal negligence while on the job; failing to follow proper protocol and place-of-work policies; you are under the influence of any drugs and/or alcohol, or a third party is responsible for causing your injury.
4. What benefits might I be eligible to receive?
Medical: Benefits paid to your to cover the costs of all medical treatment and care related to your injury. Your employer will choose the medical provider you may seek treatment from; otherwise, if you receive treatment from any other person non-authorized by your employer, you may lose compensation benefits. Costs related to transportation to medical treatment appointments may be covered under workers' Compensation: If your claim is permissible, your employer or your employer's insurance provider
Wage Compensation Benefits:
- Temporary Total Disability: compensation paid to an employee who is unable to work or earn a living as a result of the work-related injury.
- Warning: These are not benefits per se, but a liability against you should you accept employment in a similar or same capacity after filing a claim at the job where you were injured. This can constitute fraud and cause you to lose potential future benefits.
- Permanent Total Disability: These are benefits paid when a medical professional determines that you are completely and permanently incapable of returning back to work or seeking employment as a result of your work-related injury.
- Permanent Partial Scheduled Disability: Benefits paid when you suffer a complete or partial loss of functionality to a body part or organ due to a work-related injury/illness. This is calculated as a percentage of disability after treatment for recovery has been completed.
- Permanent Partial General Disability: This is compensation for injuries that result in a permanent partial disability that does not fall within the permanent partial scheduled disability category. These benefits are also calculated as a percentage of disability after treatment for recovery has been completed.
- Survivor Benefits: Benefits paid to your surviving spouse or dependent children should you die as a result of your work-related injury. Burial expenses are covered for up to $5,000.00.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
Your employer is expected to file a report with the director of the workers' compensation division within twenty-eight (28) days of learning of your accident. The statute of limitations (the time in which you may file a claim or dispute a claim) does not start to run until your employer files a report.
If after filing a claim with your employer or your employer's insurance provider you continue to have disputes regarding workers' compensation benefits, you may contact the Workers' Compensation Commission's Judicial Unit to potentially help resolve the issues. The Judicial Unit is comprised of ten administrative law judges who preside over hearings at the division and make a determination based on facts/evidence presented.
Preliminary hearings are scheduled with ALJs to make initial determinations of benefits. The determinations are typically made within five (5) days of the hearing. To schedule a hearing, you or your employer must file an application with the Workers' Compensation Division.
Mediation services are also available through the division. Mediation is highly encouraged to handle disputes between employer and employee. A mediator can be provided free of charge and mediation is a very viable solution to handling issues/disputes arising from workers' compensation claims.
The Workers' Compensation has an established Ombudsman Division where you may receive information and assistance in dealing with your workers' compensation claim.
6. If I am not happy with the determination, how do I appeal?
If you are not happy with the determination of the ALJ, you may file a review with the Workers' Compensation Board within ten days of the ALJ order. You must file this request with a division office of the board and submit five (5) copies of your filing.
After the filing request has been made, a briefing schedule and hearing date are set and notice is sent to all of the parties. Appellant has thirty (30) days from the application filing date to submit a brief and appellee has twenty (20) days. Appellant may follow up with a reply brief within ten days of appellee's brief submission date. After the briefs have been submitted, the Board will determine whether oral argument will be necessary to the case.
An action by the Workers' Compensation Board is reviewable and may be appealed to the state court of appeals within thirty (30) days of the Board's action.