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 the appropriate medical care and attention to treat your injury, especially in cases of an emergency. The law requires you to notify your employer of a work-related injury within seven (7) days of the accident occurring or sooner if possible.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Workplace Safety & Insurance is an exclusive employer financed, no-fault insurance state fund that covers work-related injuries, deaths and diseases. Nearly 21,000 employers participate in the Workplace Safety & Insurance program, and most employers are automatically enrolled in the coverage program. Employers who designate North Dakota-residence or out-of-state employers working in North Dakota with significant contacts are expected to participate. However, if you are unsure about the coverage your employer is providing, speak with your employer or contact Workplace Safety & Insurance.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
The most important role you can play as a claimant is to stay informed and in regular communication with your doctor about the status of your injury and medical treatment. Your benefits can largely change depending on how severe your injury is and whether you are able to return back to work. You should also provide your employer with updates on your condition. Transparency is key. This also means you should have detailed records in your possession and obtain copies of forms you have filed or correspondences you may have received or made throughout the process.
4. What benefits might I be eligible to receive?
All claims filed with North Dakota Workforce Safety & Insurance are either wage-loss claims or medical-claims. This means that you could be eligible for payments related to the medical expenses associated with your work related injury, or also eligible for payments to compensate the loss of wages for days missed at work as a result of your injury. To qualify for wage-loss benefits, you must be unable to attend work for five or more days and/or have a loss in wages. The wage-loss benefits will also be calculated based on the extent of your injury and the extent it prevents you from maintaining gainful employment. North Dakota workers' compensation law outlines three categories of wage-replacement benefits for individuals who have missed five or more days of work: Temporary Total Disability, Temporary Partial Disability, and Permanent Partial Disability. The three categories are described more thoroughly below:
- Temporary Total Disability (TTD) - If your disability is total, but only temporary, you will be paid a TTD wage replacement benefit. Additionally, you may receive up to $15 per week for each dependent child you support.
- Temporary Partial Disability (TPD) - If your wages are reduced due to a limitationstemming from your work related injury, you will be qualify for TPD wage replacement benefits. If your wages return to ninety percent (90%) of your gross weekly pre-injury wages, you will no longer be eligible to receive TPD. TPD benefits can only be paid up to five (5) years for those suffering a loss of earnings capacity after July 1, 1991.
- Permanent Total Disability (PTD)- Only workers who are totally disabled and unable to return to work of any kind are eligible for PTD.
In addition, you may also qualify for Permanent Partial Impairment benefits which are paid to you after you have reached maximum medical improvement.
Workforce Safety & Insurance also provides vocational and rehabilitation services to help you either return to your previous profession or seek other forms of gainful
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
The claims process begins when North Dakota Workforce Safety & Insurance receives one of the following: 1) A First Report of Injury Form 2) Receipt of a claim filed over the phone 3) receipt of claims filed over the internet. You have one year from the time of your accident or injury or two years after your death for you or a family member to file claim in any of the above three ways. Once your claim is processed and registered in the Workforce Safety & Insurance system, a claims analyst will review your claim and make a determination about whether to accept or deny your claim.
If you are unhappy with the decision regarding your claim, you may contact the Decision Review Office to discuss your options moving forward. The Decision Review Office will review your claim information, potentially request additional information, and provide you, in writing, the results of the review. Typically, one of three things can happen at this stage: a reversal of the Workplace Safety & Insurance's order; an alternative resolution that is agreed upon by both you and your employer; or no change to the determination.
6. If I am not happy with the determination, how do I appeal?
North Dakota is a monopolistic state; the Workforce Insurance & Safety program is an exclusive coverage program for North Dakota employers. After exhausting all options during your claims process, consult with an attorney or contact Workforce Safety & Insurance to discuss any potential opportunities there may be to review your claim.