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 on the job, make sure to report your injury to your supervisor as soon as possible. This should preferably be done in writing, reflecting upon as many details about the nature of the accident as you can. Seek the appropriate medical attention if necessary and also be sure to update your employer about your medical condition. Your employer should fill out a First Report of Injury form upon learning of your accident. This should be done within seven (7) days of the date of your injury or seven days (7) of your employer learning of your injury.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Your employer is not required to provide workers' compensation insurance; however, this is at the employer's own risk because they may find themselves unprepared to deal with the circumstances and costs associated with work-related accidents. Your employer may choose to purchase a workers' compensation insurance policy or decide to be self-insured. In either situation, the insurance company or the self-insured employer will pay the medical costs associated with treating your injury.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
It is highly recommended that you follow the deadlines and filing requirements of both your employer and the state's Department of Labor and Regulation to help insure the maximum receipt of benefits in your claim. Depending on the nature and circumstances of your work-related accident, you may be prevented from receiving benefits. In most cases where an injury is the result of willful misconduct, failure to observe workplace rules and regulations, intoxication, or illegal drug use, you will not be permitted to receive benefits.
4. What benefits might I be eligible to receive?
Depending on the nature and circumstances surrounding your work-related accident, you may receive one or more of the following types of benefits:
- Reasonable and Necessary: Payment for all reasonable and necessary medical care and treatment.
- Temporary Total Disability; a weekly benefit paid by your employer and/or employer's insurance provider to you equal to roughly two-thirds of your weekly earnings. These payments begin if you are unable to return to work for a period of seven (7) consecutive days as a result of your injury.
- Temporary Partial Disability: compensation paid to you should you be able to return to work but at a lesser capacity than you were accustomed to prior to your injury. The amount of benefits you would be likely to receive is a percentage of the difference between your pre-injury wages and your post-injury wages.
- Permanent Partial Disability: a one-time payment for impairment to certain body parts.
- Permanent Total Disability: benefits paid to you for the duration of your life if your injury results in total impairment of disfiguration.
- Death Benefits: benefits paid to your survivors or dependents should your injury result in your untimely death.
- Rehab & Retraining: benefits to help you seek alternative employment.
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 or your employer's insurance provider will contact the Division of Labor and Management with the information pertaining to your claim. Upon accepting liability for the accident, the insurance provider or your self-insured employer will begin paying for all necessary medical expenses related to your injury. This may be inclusive of wage-loss benefits should your injury prevent you from returning to work for a period of seven (7) consecutive days or more.
If you feel as though your claim is being mishandled, you should first call the claim adjuster at your employer's insurance company or your employer and try to resolve the issue. Next, call the Division of Labor and Management and speak to a specialist about your problem. If at this point the situation has yet to be resolved, you may choose to pursue a variety of options available through the Division of Labor and Management. You may try to work through the issues via a mediation held with a division representative or you may file a petition for a hearing. You must file a petition for a hearing within two (2) years of the date of denial of benefits.
6. If I am not happy with the determination, how do I appeal?
If after going through the hearing process and receiving a final order and determination by the Department of Labor and Regulation, you or your employer may pursue an appeal to the state circuit court for additional review. All appeals will governed by all applicable court rules and procedures.