Who is Eligible for Filing a Workers' Compensation Claim?
Workers’ compensation eligibility depends on several factors, including what state the employee’s job is in, if the employee works for the federal government, and even the industry (for example, the railroad industry has its own system spelled out by a special federal law). All in all, most employees are covered by a workers’ compensation plan of some sort.
For example, with some exceptions, in Florida employers who have four or more employees, and construction companies with even just one employee, must provide coverage; and in Georgia businesses with three or more employees must provide insurance, with some liable for subcontractors’ employees. In a state like New York, essentially every employer must offer insurance. In Massachusetts, the requirements are similar, although there are more exceptions than in New York.
The majority of unintentional injuries, diseases, illnesses, accidents, and deaths occurring in the workplace are covered by workers’ compensation laws. Importantly, because workers’ compensation is a no-fault system, workers are not required to prove fault for their injuries to recover benefits.
In many states, a worker must report a workplace injury to his or her employer within 30 days of the accident. The employee has a certain amount of time after the initial injury report to file a workers’ compensation claim — in some states that’s two years.
When first reporting the accident, the injured worker should provide specific details, such as:
- Names of witnesses;
- Location of accident;
- Cause of accident; and
- Time and date of the accident and injury.
What Is a Workers’ Comp ‘Independent’ Medical Examination?
Next, the injured worker will seek an immediate medical evaluation to determine the extent of their injury by an approved, “authorized” medical provider of their employer’s choosing — the specifics of this may be different depending on the state. If an injured worker seeks a second medical professional’s opinion, depending on their state there could be certain restrictions on this. For example, in Florida workers can only switch doctors once.
To receive workers’ compensation, injured workers must submit to an independent medical examination or insurance medical exam. An IME, in theory, clarifies the worker’s medical condition and determines if the injury was caused by work-related activity. While the IME is meant to provide an accurate diagnosis and recommend appropriate treatment, insurance companies often use this as a tool to limit payouts and liability.
Assigned doctors can work in tandem with insurance companies to protect the financial interests of both parties, sometimes by denying the existence of an injury or wrongfully clearing an employee to return to work. To ensure that you are receiving the right prognosis, it is important to have an experienced attorney help you through the process.