Injured On the Job? How to Claim Workers Compensation Benefits

Business.com / HR Solutions / Last Modified: February 22, 2017

Staying safe at work is top priority, but here are few guidelines should you have the unfortunate happening of a work-related injury.

With employment comes responsibilities, benefits, and possibly, some perils. You may be injured at some point, no matter how hard you try to avoid it. Though workplace injuries may be unavoidable, it's important to what to do when you receive a work related injury or illness.

Each state has its own laws and regulations related to workplace injury which are essential for the workers to understand to make a strong legal claim. When you file a claim, you receive workers compensation benefits, which are specially designed to aid the employees in times of need. 

Related Article:5 Tips to Prevent the Most Common Office Accidents

Here are few guidelines to take into account if you are to get a work-related injury. Depending on the injury and if you qualify for compensation, it's an employee's right to claim workers' compensation benefits.

Filing a Claim

According to the U.S. Bureau of Labor Statistic, private industry employers reported over 3 million workplace injuries and illnesses in 2013. More than half of these injuries were of a serious nature that led to job transfers or days away from work.

Considering this, it is important to file a workers compensation claim right after the injury. Once you inform your manager, he or she should give you a workers compensation form within 24 hours of reporting.

Fill the form out and send it in with complete information. Your employer should fill out their part of the form and send it to their insurance company. Make sure to keep a copy for your records. The insurance company should not take more than two to three weeks to get back to you with a response.

Here is a list of some primary benefits you may receive once you file a claim:

Medical care: treatment for any injury or illness caused during work. This essentially includes immediate medical treatment including hospital care, tests and other fees. 

Temporary or permanent disability benefits: an employer covers a work-related injury that may prevent you from carrying out your everyday duties at work for a period of time. 

Death benefits: in case of an employee’s death due to injury or illness at work, the employer is liable to compensate and make payments to the deceased spouse, children or other dependents.

Dealing with Disagreements from the Claims Administrator

The claim administrator is likely to disagree with parts of your claim at one point or another.In such a situation, consulting an attorney who specializes in worker’s compensation can help you come to a mutual settlement. Your attorney and claim administrator will then mutually agree on a physician and appoint him or her for you treatment.

Related Article: Why Even a Small Business Needs Workers' Compensation Coverage

In Case of a Denied Claim

Many times, a claim administrator will initially deny your claim. This means he or she has deemed your work-related injury not to be eligible for workers compensation. In such a case, an attorney can be of great help.

Often, workers are not entirely aware of the nitty-gritty of the laws and their rightful benefits. Attorneys understand the situation and can come to a fair deal with the employer or insurance admin in order to compensate the injured or ill employee.

In case of denial, you will need to file a case and present it to the claims administrator in front of a judge. If you have an attorney, he or she can best guide you through the entire process of hearing and will advise you to keep your claim on track, which will enable you to receive positive settlements at the end of the session.

Settlements and Agreements

If the judge rules in your favor and you reach a settlement with the claims administrator, you are eligible for workers compensation from your employer. The claims personnel then decides the compensation amount that you are to receive, which will be paid weekly or by lump sum. The insurance personnel also makes payment for your future medical payments unless they are included in the lump sum amount that is paid together at once.

Work injuries typically occur in high-hazard environments, and thus it is important for employees to understand the policies, procedures and laws for workers compensation. However, managing a case can sometimes get complicated and in this situation a workers compensation attorney can play a vital role by providing his or her dedicated services to ensure you are fairly compensated for work-related injuries.

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