Guide to Help You Navigate the Workers Compensation Claim Process

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Making a Claim

First, you should know that millions of claims are submitted each year. Some are frivolous, but many that are denied are legitimate. Why do they get denied? The Workers Compensation claim process is not for amateurs. Here are some pointers to help you navigate the rough waters of the claim process of Workers Compensation.

Hire a Workers’ Comp Attorney

When it comes to making a workers’ compensation claim, the best action you will ever take is engaging the services of expert workers’ comp legal advice.

There is no such thing as a simple claim. A competent attorney will ensure you complete the right forms, provide accurate information, and meet deadlines. Legal representation often makes the difference between having a claim accepted and avoiding a reduced payout.

Your attorney will advise you whether you have a legitimate claim and what you need to do to navigate the workers’ comp claim system.

Know Your Benefits Plan

Make sure you know what your workers’ comp insurance plan covers before you need to make a claim.

For example: Does your plan provide short-term or temporary disability for those who have to be off work to recover?

Is there a permanent disability clause in your plan in case you are unable to return to work?

What medical treatments, rehab, or long-term care is provided?

If you are unable to return to the work you were doing is there a rehab/retraining clause in your plan?

What compensation exists for travel to specialists, treatment facilities, rehab centers?

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Report an Injury Immediately

When it comes to making a workers’ comp claim, time is of the essence. In order to have your paperwork in place, report your on-the-job injury to your immediate supervisor and your employer.

Each state has established deadlines for reporting. Don’t delay. Missing a deadline may well mean your claim is denied.

Seek Medical Attention

Do not adopt the “maybe it’s nothing” attitude. When that ache or stiffness turns into a chronic injury, if you did not seem medical help you won’t have the evidence you need to make a claim. Make sure there is a paper trail from the outset.

Keep Detailed and Organized Records

Retain copies of all paperwork regarding your workers’ comp claim. Get everything in writing! Have a letter about work restrictions, employer correspondence, correspondence from the workers’ comp insurance company, workers comp forms, accident report, reports from doctors, work restriction documentation.

See an Unbiased Doctor

If the doctor is affiliated with the workers’ comp carrier, there may be a conflict of interest and may thus, minimize the seriousness of your injuries. It is wise to seek a second opinion from a medical professional not employed by the workers’ comp carrier as soon as you can.

Expect to Undergo Medical Examinations

If your claim is significant and your injuries are serious, expect to be ordered to undergo a medical examination from an independent medical facility—perhaps one affiliated with workers’ comp. This examination aims to make sure your diagnosis is legitimate, and your treatment is necessary.

They Walk Amongst Us

It’s no exaggeration. Investigators are watching those who have made costly workers’ comp claims. Do not expect that, once your claim is approved, you are home free. If you are off work on a temporary to permanent disability or you are on extended rehab, your credibility is being scrutinized.

If Your Claim is Denied

Always be prepared to appeal workers’ comp decisions. That is another place where having an attorney who specializes in workers’ comp cases is necessary.