In many states, employers are required to have workers’ compensation insurance that covers employees who sustain injuries in their workplace. However, specifics of the process of workers’ compensation claims vary by state. Generally, injured employees must notify their workers’ compensation carriers and employers. Regardless of your state laws, you are entitled to get medical attention first. So, if you get injured while working, you are entitled to your lost wages and medical costs. Here are useful tips on the worker’s compensation claim process that can help you get started.
1. Notifying/Reporting the Injury or Illness to the Employer Immediately
According to the workers’ compensation laws, if you get injured on the job you are required to report to your employer immediately. Additionally, if the illness or injury is beyond first aid, your employer must give a report about it within 7 days. The First Report of Injury is issued to the insurance carrier who in turn reports in the injury or illness to the local Labor Commission electronically. You are then given your copy of the report. This immediate notification will allow you to promptly start receiving the necessary medical care so that you can return to your work as soon as possible.
2. Independent Medical Examinations (IME)
After you’ve successfully reported a work-related illness or injury, the insurer has the right to refer the injured worker to a doctor of its choice, according to Kenton Kozszdin from Kentons Law Office. Usually, this exam is commonly known as IME, but it’s dependent. The workers’ compensation insurer carefully chooses a doctor that it can trust to deliver a detailed medical report. During this exam, you will be required to explain about your physical history and how you got injured. The doctor may also ask you some other question before examining you. The insurer may terminate your benefits if you don’t comply accordingly with the doctor’s requests.
3. Compensable Claim
If the doctor determines that you will lose work time and your claim is compensable, the workers’ compensation insurer is required to contact you and your employer to determine the weekly pay rate that you will receive for the days that you will be off work. The insurance carrier should pay all medical bills and you will not pay anything for the medical treatment received.
4. Denial of the Claim
If the workers’ compensation insurer denies that your claim is compensable, the insurer will send a denial letter to you and the Labor Commission of the state.
5. Hearing Application
If your claim is rejected, you can apply for a claim hearing at your local Labor Commission so that an administrative law judge can determine whether your claim is compensable or not. While this is going on, you may require your private health insurance company to cover your medical expenses.
These are the most important steps any injured worker should follow to ensure he/she receives the benefits of workers’ compensation claim. The process is simple it can a complicated on if you ignore these important guidelines.