Filing for workers’ compensation following a workplace injury is a generally simple process when injuries are nominal and the prognosis for the employee to return to full working capacity is apparent. In most situations, the employee reports the injury to the employer, often times including reporting an accident or other action by a co-worker.
Injuries occur in a wide variety of work situations, including remote working locations, and these injuries will also have an associated accident report. But, some work injury scenarios are not simple and all employers are not necessarily agreeable to the claim filing when they think they can avoid paying damages, even when the insurance company provides the funding.
- Depending on the state structure for workers compensation, the respondent insurance company can deny payment of a claim as well if their investigation results in information they can use in defense.
- In states that have not privatized workers compensation insurance protection, even the state can rule the worker is not eligible for workers comp benefits.
- Regardless of the party denying a claim, it is important to retain an experienced workers compensation insurance attorney who will know how to get the claim filed properly and argue successfully on behalf of the injured worker claimant.
Filing a Typical Work Injury Claim
Generally speaking, most claims follow these steps:
- The injured employee reports the injury to the employer as soon as possible.
- The injured employee should immediately seek medical treatment regardless of whether the employer approves. Many injuries can be dangerous and even life-threatening occurrences that require timely medical attention.
- It is then the responsibility of the employer to conduct an accident investigation or review the causation of the injury and file the report with the insurance company or state board when the report is compiled.
- If all parties are agreeable and the state validates the claim, benefits should begin after seven days of inability to work and include wage replacement and medical bill coverage.
Filing a Questioned Work Injury Claim
For problematic work injuries, it is often necessary to file the claim personally or retain an attorney who can begin the process. The following points should kept in mind:
- All injury claims must be reported to the employer or state board within 30 to 45 days, depending on the state, from the time the injury was realized.
- Many times there are no accident reports associated with these claims when the injury was only considered as soreness when developing.
- These types of cases can be complicated and are always well-defended, and having an aggressive and experienced Palm Beach County workers compensation attorney is vital for equitable compensation.
- The diagnosis and prognosis of the attending medical professionals are very important to these claims, as this will be the primary supporting medical documentation used as a basis for the filing.
The Hearing Process
There is a standard hearing process that begins immediately after a claim is denied. It includes a state workers compensation board judge who will evaluate evidence from all parties and issue an initial formal ruling.
- These hearing rulings can then be appealed when the representing attorney thinks they can prove the injury claim is valid and the injured claimant is entitled to benefits.
- If an employer continually requires workers to perform job duties in unreasonable dangerous conditions, punitive damages can be pursued. This may include non-economic damages for pain-and-suffering.
If you have questions or concerns about your workers comp claim, seek the legal guidance of an attorney who practices law in this area.
Thanks to our friends and contributors from the Law Offices of Franks, Koenig & Neuwelt for their insight into the workers compensation process.