Accident at Work: How to File a Claim

Accident at Work: How to File a Claim

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Accident at Work: How to File a Claim

If you've been hurt in an accident at work, it is imperative that you report the accident as soon as possible. If you fail to report your accident in a timely manner, this can negatively affect your chances of recovering compensation in a claim or even your relationship with your employer. Furthermore, your employer needs to be made aware of the incident, and you need to be able to attend medical appointments to recover from any injuries as much as possible.

If you or someone you know has been hurt in an accident at work, you may be entitled to compensation. Make sure you and your family receive what you’re owed and have the means to move forward with your lives. You can fill out a free, no-risk case evaluation to get started.

Worker's Compensation Claim Process Information

If you've been injured on the job, the first step is always to take care of yourself and seek treatment if necessary. But as soon as possible, you need to open a workers' compensation claim. When an employee sustains a work-related illness or injury there are a few steps that must be taken in order to ensure that the workers' compensation claim is filed so that benefits can be approved.

Failing to report in a certain period of time could lead to a denial of workers' compensation benefits so it's important to communicate with your employer as soon as possible and let them know what happened. Your employer is usually the one who is responsible for formally submitting that claim to workers' compensation insurance companies, but they will not be able to do this without the documentation, evidence, and details that you've gathered about the individual incident.

What Happens Once an Employee Files a Claim

An employee will need to fill out paperwork regarding the date, place, time and circumstances of the injury. This will be used to submit to the workers' compensation insurance company but also helps to document things regarding how the accident happened. If any witnesses saw the incident in question, they should be interviewed and their statements should be included in supporting documentation for a claim. The completed form gets filed with the insurance carrier and the state workers' compensation board might also require the first report of injury form to clarify when the formal report was made about your accident at work claim.

When reporting the injury to an employer, state guidelines will determine how long the employee has to do this. For example, in the state of New York, the period is a maximum of 30 days, whereas some other states will allow an employee to report an injury within a year or even longer.

Certain injuries may require immediate medical treatment, but others may require a doctor's medical care and diagnosis. Furthermore, the employee might also need to seek non-emergency treatment. After the claim form has been submitted by the employer, the insurance company will evaluate their provided information and either approve or deny the claim. In the best-case scenario for the worker, the claim is approved and they are able to begin receiving benefits immediately for their on-the-job injury. The insurance company will then inform the employer about the approved claim and contact the employee to tell them about payment details. The employee does have the right to accept this insurance company's offer or negotiate for a larger structured settlement or a lump sum payment. The insurance company's payment offer is based on the accident and the injuries sustained but can include compensation for things like disability payments, prescriptions, medical bills, and a portion of lost wages. Unfortunately, many workers have their claim denied the first time around. If your workers' comp insurance company denies your benefits, you have the ability to file a claim.       

Most Common at Work Injuries

Work injuries can and do happen in any location or line of work, but some places are more likely to have onsite accidents than others. Those most likely to get hurt on the job include:

  •       Loggers
  •       Construction workers
  •       Gas and mining operations
  •       Garbage collectors
  •       Roofers
  •       Delivery drivers
  •       Ironworkers
  •       Power linemen
  •       Farmers
  •       Firefighting supervisors
  •       Crane operators
  •       Landscapers
  •       Mechanics
  •       Police officers

Some of the most common workplace injuries include:

  •       Overexertion and bodily reaction injuries like repetitive motion and non-impact injuries
  •       Slips, trips, and falls
  •       Contact with objects
  •       Electrocutions
  •       Burns
  •       Broken bones

For many of the serious injuries, you’ll have to miss at least some time at work. You might not even be able to go back to the same job you had before due to the physical demands of the job, which can now be too difficult to perform with your new injuries. If this applies to you, make sure you consider all possible injuries that could be named in your workers’ comp claim.

If you need further rehab, this can help you get trained in a new skill so you can go back to work. But for most people, their life will be forever changed as a result of their accident at work claim.

What to Know About Declined Workers’ Comp Claims

It can be shocking to realize that your claim was denied when you submitted plenty of evidence that you suffered an on the job injury. You could get denied for a workers’ comp claim for something as simple as you not meeting the eligibility requirements or as complex as claims that the accident was your fault to begin with. Here are some reasons why the workers’ comp insurance company might kick back your claim and what options you have to respond.

Injury Not Reported on Time

State laws all determine the time period in which you have to report your injury to a supervisor. Usually, this is within a few days, but it’s always in your best interests to do this one the day of or the day after the injury. State laws also determine if the claim was not filed on time. This period is usually no longer than 30 to 90 days and this is where the employer needs to report the claim to the workers comp board.

Employment Disputes

One of the biggest challenges that can arise in a workers’ comp denial is when the supervisor says the injury didn’t happen during the course of work. Any other disqualifying reason could also be brought up at this time, such as if you were under the influence of alcohol or drugs or were involved in horseplay at the time the accident happened. If you were not on the job when the wreck happened or if you were on the way to work, that is unlikely to be covered.

Non Compensable Claims

Insurance can also deny a workers’ comp claim for an argument that the injury is not covered at all. Some stress-related injuries can prove problematic in certain states, for example. If you’re not sure whether or not your case could lead to an approved claim, you might prefer to hire a workers’ comp lawyer sooner rather than later for your accident at work claim.

No Medical Treatment

If you didn’t get medical treatment for your injuries, the workers’ comp claim investigators might see that there’s no real need for you to get compensation for your injuries.

Insufficient Evidence

While there are many reasons your claim could get denied today, insufficient evidence is one that is easily avoided. By having a strategic plan submitted with your original claim or your appeal, you increase your chances of approval.

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Get answers to commonly asked questions about our legal services and learn how we may assist you with your case.

Morgan & Morgan

  • When do I really need a workers’ comp lawyer to help me?

    You can hire an attorney whenever you want in your case, but it’s really important to get help when you’re dealing with a denial or a complex claim. If you are currently handling an appeal or are about to start one, get help now.

  • Can I go to my own doctor?

    Your individual state laws will determine if you are able to see your own doctor. Ask your employer directly if you need to see a doctor assigned to you by them or if you can go to your own doctor’s appointments. Even if you are required to go to their doctor, you can also ask if you can switch after a certain period of time. If you’re required to go to a doctor they assign you, you can, of course, continue on with any regular medical appointments or physicians you need to see on your own during that time as well, but do not ignore your appointments with the assigned physician.

  • What benefits can I get from workers’ compensation?

    The benefits you’ll get will depend on the nature of your injury and your state laws. If you are not able to work for at least a few days, you will likely be eligible for temporary disability benefits. These are equal to two-thirds of your regular wages at the time. If you are living with permanent damage as a result of your accident, you might be able to get permanent partial disability benefits.

    If you still need medical treatment because of the injuries you sustained at work, you could be able to tap into vocational rehab and the costs of your medical treatment for as long as needed. The severity of your injury will dictate what you can receive and for how long. As you might expect, more severe injuries can lead to lengthier benefits.

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