5 Things to Know About Worker’s Compensation

If you’re hurt at work, the worker’s compensation system serves as a replacement for personal injury lawsuits. Worker’s compensation applies to the vast majority of injuries related to work and occupational illnesses. 

A worker’s compensation claim is usually no-fault, but you’re limited to seeking compensation for economic damages only, including medical expenses and lost earnings. You can’t claim damages for non-economic damages like pain and suffering. 

The following are five things to know about worker’s compensation. 

1. The Process

If you’re hurt on the job, or you become ill because of something related to your work, you have a restricted amount of time to report your injury and file a claim. If you don’t do so within this time window, you may have your insurance benefits denied. 

Employers have the responsibility to train employees to immediately report workplace injuries. Employers are responsible for submitting claims to their worker’s compensation carrier, but they need details and documentation about the incident first. 

After an employer learns someone was hurt at work, they should seek the employee to get medical treatment right away. The employer is responsible for providing the employee the necessary paperwork to fill out, which will include the date, place, and time the injury took place and an overview of the circumstances. 

The employer is responsible for interviewing witnesses as needed and including their statements in the claim’s supporting documentation. The completed form needs to be filed, along with the claim documentation, with the employer’s insurance company. 

An employer also needs to make sure they submit the first report of injury form to the worker’s compensation board in their state if required. 

Worker’s compensation laws are set by the state, so you have to check them to ensure you’re in compliance because they differ around the country. 

2. The Injury/Illness Report

Employers might create their own incident reports. Some employers will use the first report of injury form or a form provided by their insurance carrier. 

Some employers may decide to have the employee who’s hurt or ill complete the report, but in other cases, they may complete it with the help of the employee. 

The report will include the date the employee received the form and the date they returned it. If the employee is given the form to complete, the representative should give them a deadline to complete it. 

Most employers will request that the form is completed no later than 24-48 hours after an incident so that an employer has time to do an investigation in a timely way. The employee’s doctor will also need to submit a medical report as supporting documentation. 

3. Getting Medical Treatment

As mentioned above, a doctor will need to submit a medical report with a worker’s compensation claim, highlighting why it’s so important to get medical treatment right away. Medical records are a critical piece of evidence in a worker’s compensation claim. 

If you’re hurt at work and you wait to get medical care, the case can potentially be made that your injuries weren’t caused by the accident. 

4. When You Should File a Claim

Your illness or injury may qualify for worker’s compensation benefits if it occurred on the job or even within the scope of your employment. This could include exposure to occupational illnesses or diseases from exposure to harmful chemicals or hazards while you’re on the job. 

To file a claim, several things have to be true. The employer must have an active worker’s compensation policy, the injured worker has to be an eligible employee of the business, and the employee must have been injured while at work or due to work conditions. 

There are certain things worker’s compensation doesn’t cover, including stress or psychiatric injuries. Self-inflicted injuries, injuries caused by horseplay or fighting, and injuries occurring during a commute aren’t covered. 

Injuries that occur while committing a crime, while violating company policies, or while under the influence of drugs and alcohol are also not covered by worker’s compensation. 

5. Common Reasons a Claim is Denied

There are a few key reasons that worker’s comp claims are denied. These include:

• Your coverage that’s provided through your employer’s policy might mean that you have to see a particular care provider after you’re hurt. Depending on your state, you might have to always see someone in-network or see them at least for your initial medical appointment. If you’re injured and choose your own doctor when you were supposed to see someone in-network, your claim might be denied. You need to see the right doctor. That doesn’t mean you can’t see your own doctor later, but you need to at least see the in-network provider for the purposes of your claim.
• If you have a pre-existing condition, a worker’s comp insurance carrier can deny a claim. This is a tough one because a lot of people have pre-existing health conditions. You aren’t automatically disqualified, but it can make things harder. If an insurance company is trying to blame your injury or illness on a pre-existing condition, you may have to work with an attorney.
• A delay in paperwork or a clerical error might not seem like a big deal but can end up disqualifying you for worker’s comp. Clerical errors can be the sole reason you’re denied. You need to make sure you fully understand all deadlines and the required paperwork.
• Interference from the insurance company can be problematic. Every claim is unique, so there could be some sort of legal issue that pops up, or the insurer might not be cooperative. The insurance company may be hoping you give up on your claim by making things challenging and frustrating for you.

Finally, as mentioned above, worker’s compensation only covers accidents that lead to injuries that are unintentional. If you were horseplaying or you weren’t behaving professionally when you’re hurt, your claim is likely to be denied. At the same time, you can be responsible for your injuries but still have worker’s comp eligibility as long as you weren’t being intentionally neglectful.