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, you should 1) seek the appropriate medical care necessary; 2) provide written notice to your employer as soon as possible, if not immediately; and 3) file a workers' compensation claim.
Upon notification, your employer should report the details of your injury to the employer's insurance provider within five (5) days. The insurance provider will make its assessment of the circumstances surrounding your injury and make a determination of whether to accept liability. You should receive notice of the determination, whether in the affirmative or the negative, with details of the reason why the determination was made as it was.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Your employer is expected to provide a workers' compensation insurance coverage policy to employees. However, state law permits the employer to become a certified self-employer or to purchase an insurance policy from a private insurance provider. You should discuss what insurance policy your employer provides.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
Observing the applicable filing requirements and keeping detailed and accurate record of the circumstances associated to your claim will help you to move forward in the claims process.
4. What benefits might I be eligible to receive?
The amount of benefits you may be entitled to will depend on the extent and severity of your injuries. Some examples of benefits you may entitled to include:
- Medical Benefits: Payments made to cover all reasonably necessary and related costs associated with the medical treatment of your injury.
- Temporary Total Disability: Wage replacement benefits paid to you if you are unable to return to work for a period of more than three (3) consecutive days.
- Partial Disability Benefits:Payments to compensate you for the difference in wages you received prior to your injury and after your injury.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
Upon notice from the insurance provider regarding the determination to accept or deny your claim, the insurance provider must give you notice that you have sixty (60) days to file with the Office of Judges. This will serve as a constructive complaint made against the insurance provider. The insurance provider must respond with an answer to the complaint within fifteen (15) days of notice of the complaint. A hearing will subsequently be scheduled in front of the Workers' Compensation Commission where each party will be able to present an argument and evidence supporting that evidence, much like a trial. A hearings officer will preside over the hearing. At the end of the hearing, the hearing officer will prepare a report and recommendation to be approved by the Workers' Compensation Commission. Both parties will be awarded seven (7) days to file objections and comments to that report and additional three (3) days to respond to the opposing party's objections. The commission will then decide whether to accept or reject the recommendation of the hearing officer. This will constitute a final order.
6. If I am not happy with the determination, how do I appeal?
Any subsequent appeals may be made to the state court, subject to all applicable rules and procedures.