How to File a Workers’ Compensation Claim

How to File a Workers’ Compensation Claim

How to file a workers’ compensation claim varies by state. In some places, like South Carolina, the process is relatively straightforward. You start by notifying your employer of the on-the-job injury within 90 days of the incident.

Then, you must file a Form 50, usually within two years. From there, the liable insurer evaluates your claim, and you start receiving benefits until you reach maximum medical improvement and can return to work.

Not every workers’ compensation claim goes this smoothly. The insurer could deny your claim. Your employer could contest your injury’s severity. In those instances, you could benefit from partnering with a workers’ compensation lawyer. They can file your workers’ compensation claim and pursue the benefits you need.

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Steps to File a Workers’ Compensation Claim

How to File a Workers’ Compensation Claim

Here’s a more in-depth explanation of how to seek workers’ compensation benefits:

You Report the Injury to Your Employer

Reporting the injury to your employer immediately after the accident does more than help your case; it’s mandatory. While you generally have 90 days to notify them, ideally, you should do so as soon as possible. This creates a record of your on-the-job accident and protects your right to seek benefits.

You should notify your employer in writing. In your message, be sure to include certain details, such as:

  • The date, time, and location of the incident
  • The injuries you sustained
  • Whether you’ve already sought medical attention
  • Your intention to seek workers’ compensation benefits

Documenting these items in writing prevents disputes later.

You Fill out a Form 50

In addition to notifying your employer, you must fill out a Form 50. Here, you must include:

  • Your name, address, and contact information
  • Details about your condition, including how the accident occurred
  • Your weekly wages
  • Whether you had a pre-existing condition before the incident
  • Any unusual aspects of your claim

If you’re concerned about incorrectly filling out this form, a lawyer can guide you through the process. They can also advise you on whether you should send information in addition to the Form 50.

You Wait for a Decision

After you file a workers’ compensation claim, you wait for the insurance company to make a decision. Typically, you learn of the decision within a few weeks. If you need emergency medical care during that time, your employer’s insurer should cover it. However, if you see your regular doctor for a non-emergency issue, the insurer would not pay for it.

If your insurer approves your claim, you could start receiving compensation starting on the eighth calendar day that you cannot work. If not, you still have options. 

How to File a Workers’ Compensation Appeal

If your initial claim gets denied, you can file an appeal. You should consider working with an attorney if this happens. They can learn the reason for your claim’s denial and act accordingly. For instance, if you didn’t have enough evidence to support your case, a lawyer could privately investigate your accident. With more evidence, they could convince the insurer to settle.

Other steps an attorney can take on your behalf include:

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  • Negotiating with the insurance company: A workers’ compensation lawyer knows the laws surrounding these matters. They can use that knowledge during negotiations to help their clients receive benefits. With strong negotiation skills, they can help you through the claims process.
  • Filing an appeal: If your initial claim gets denied, the insurer must give a reason. A workers’ compensation attorney can address the reason for the denial and file out all appeals paperwork.
  • Checking the status of your case: A workers’ compensation attorney can continuously on your case’s progression. That way, you can make informed decisions and plans for the future. You shouldn’t feel “in the dark” about your claim.

Having an attorney during the workers’ compensation appeal offers many benefits. You can learn more about these benefits during a complimentary consultation with a workers’ compensation firm. Here, you can get answers to your most pressing questions, including how you can secure benefits after an on-the-job injury.

What Should I Do if I Want to File a Workers’ Compensation Claim?

If you want to pursue benefits after an on-the-job injury, you should:

The liable insurer may request evidence regarding your case. Supporting information can include your lab test results, imaging scans, and medications’ names. You should also get a copy of the accident report, if you filed one. This offers indisputable proof that you suffered an injury while working.

Receive Emergency Medical Attention (if Warranted)

If you suffered a life-threatening emergency, do not wait until your workers’ compensation claim gets resolved. Instead, visit a healthcare provider as soon as possible. They can stabilize your condition and offer the documentation needed to bolster your case. Furthermore, seeking medical attention immediately after your accident proves that you suffered harm.

You don’t have to struggle with uncooperative claims adjusters and insurance representatives alone. Instead, you can entrust a lawyer with those matters. This gives you the time and energy to focus on healing.

Frequently Asked Questions About Filing a Workers’ Compensation Claim

You have the right to have your questions answered. That way, you can make informed decisions about your future. Some questions you may have about the workers’ compensation claims process include:

How Long Does It Take to Receive Workers’ Compensation Benefits?

The time it takes to receive workers’ compensation benefits varies based on the circumstances of your specific case. If your initial claim gets approved, you can expect to receive benefits in less than a month. If your claim gets delayed or denied, it could take longer.

If you’re concerned about how long it could take to get benefits, you may consider partnering with an attorney. They can prevent any unjust delays from stalling your right to benefits. They can also file your initial claim and prevent a denial.

What Benefits Could I Recover Through Workers’ Compensation?

The specific benefits you can get through workers’ compensation depend on where you live and work. Yet, in general, the U.S. Department of Labor notes that you could receive four types of benefits.

They include:

  • Wage replacement benefits: You could lose substantial income while you miss work to recover from your injuries. Workers’ compensation benefits could provide wage replacement benefits, so you don’t struggle financially. Usually, you can receive up to two-thirds of your average weekly wage.
  • Medical expenses: You could require extensive medical treatments depending on the severity of your injuries. Workers’ compensation benefits could provide you with the necessary funds to cover your medical costs. Medical expenses could include emergency room costs, doctors’ visits, medications, diagnostic tests, surgeries, and hospitalizations.
  • Vocational rehabilitation: Your condition may prevent you from continuing work in your current field. For instance, if a construction accident left you unable to walk, you could benefit from a more sedentary position. Vocational rehabilitation would offer educational programs that allow you to prepare for re-entering the workforce.

These benefits can help you avoid financial struggles by providing monetary assistance. You won’t have to worry about returning to work before your body feels ready. When you hire an attorney, they can work to secure these (and other) benefits.

Can I Get Pain and Suffering Through a Workers’ Compensation Claim?

Workers’ compensation does not offer coverage for non-economic damages, such as pain and suffering. It only covers your direct financial losses, such as your medical expenses and part of your missed time from work.

How Could I Get Compensation for Pain and Suffering?

If you suffered an on-the-job injury due to another party’s negligence, you have options for seeking pain and suffering. Here, you would assert that because another party caused your accident and injuries, you have damages. For instance, imagine you were a delivery driver who suffered a car accident.

In that instance, you could file a claim with the at-fault driver’s insurance in addition to seeking workers’ compensation benefits through your employer. Yet, managing both of these processes at the same time could get complicated. For that reason, you may consider working with a lawyer. They can examine the full scope of your financial recovery options, so you can seek appropriate compensation.

Why Would the Insurance Company Deny My Claim?

Your employer’s insurer may deny your claim if:

  • It questions your injury’s origin. The insurer may ask for proof that you suffered an injury while working. Workers’ compensation does not cover incidents that happen off the clock.
  • It suspects intoxication led to your accident. Although workers’ compensation is a no-fault system, if the insurer suspects that you were drunk on the job, it could deny liability for your losses.
  • It suspects you engaged in horseplay. To get workers’ compensation benefits, the accident must have happened while you performed your regular-job related duties. If the insurer suspects that fooling around with a co-worker caused your condition, it could deny your claim.

While many people get benefits through workers’ compensation coverage, at the end of the day, insurance companies are for-profit businesses. That means it may not act in good faith when processing your claim. In that instance, you could defer all communications to your lawyer. They can deal with the insurance company and advocate for a fair resolution.

Workers’ compensation doesn’t just cover things like broken arms and herniated discs; it also covers illnesses you may develop over time. For instance, if you work as an HVAC specialist, you may have developed a respiratory condition from breathing in mold and mildew. In that instance, you could seek benefits that account for your medical expenses and a portion of your lost income.

The Benefits of Hiring a Workers’ Compensation Attorney

Hiring a workers’ compensation attorney has many benefits, especially if your claim gets denied. They understand the claims process and can guide you through it. Benefits of hiring a workers’ compensation attorney include:

They Can Ensure You Meet Deadlines

Workers’ compensation cases involve strict deadlines. If you miss these deadlines, you could miss the opportunity to recover compensation for your losses. Since workers’ compensation attorneys deal with these matters often, they know the laws in your state and the timelines you must follow.

They Can Handle Communications With the Other Parties

By handling communications on your behalf, an attorney can say and do the proper things to reach a successful outcome. Also, this can prevent you from saying or doing anything that could harm your case. Attorneys know the right things to say and do. With them handling communications, you can rest assured knowing your case is in good hands.

They Can Conduct an Independent Investigation

The insurance company will investigate your accident. Yet, it may have biases, hoping to find some discrepancy that jeopardizes your case. When your attorney investigates, they’re on your side. They look for information to support your claim, not hurt it. They may find video footage, photos of the accident scene, and eyewitness statements that could further bolster your claim.

They Can File Your Claim Correctly

You might have concerns about filling out some claim-related documents on your own. A workers’ compensation attorney knows how to fill out the forms for both an initial claim and an appeal, ensuring you fill out everything accurately and completely.

They Often Offer Free Consultations

You can typically speak to a workers’ compensation attorney during a free consultation. During the consultation, you can ask questions and get information about how that specific attorney can help with your case. Here, you can choose which lawyer best fits your case’s needs.

They Commonly Don’t Charge Upfront Fees or Costs

Jeff Morris, Workers’ Compensation Attorney
Jeff Morris, Workers’ Compensation Attorney

Many workers’ compensation attorneys work on a contingency fee. A contingency-fee agreement offers many benefits for the injured worker. You don’t have to pay legal fees unless the attorney helps you reach a successful outcome.

Without worrying about the potential costs of a workers’ compensation attorney, you can get the legal help you need. Overall, a workers’ compensation attorney can add many benefits to your case. You can focus on recovering while a personal injury attorney manages your legal matters.

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