Workers’ compensation is used to cover costs associated with workplace related injuries. Employees suffering from injuries or illnesses that occurred in the course of their work can file claims for workers’ compensation benefits in order to help them cover the cost of medical care, physical therapy or other forms of rehabilitation, and to provide financial support in the form of wage replacement while the employee is unable to return to work as a result of the medical condition.
The rules regarding and the process for filing workers’ compensation claims vary from state to state. This means the amount of time that you have to file your claim following your injury or illness may be different depending on where you work. You should therefore make an effort to file your claim as soon as possible. While the steps you will have to take to complete your claim for workers’ compensation benefits will depend on the state you are in and the nature of your injury or illness, there are certain things most people can expect to go through as part of the claims process.
Telling your employer, reporting the injury or illness
Your first step in making a claim is going to be filing that claim in the proper place. Sometimes this means filling out forms with your employer, who then takes the claim to their insurer, but in some states the claim must be filed by the injured party with the state agency responsible for handling workers’ compensation cases.
If your employer seems reluctant to cooperate with your request to file a claim, you should speak with an attorney. However, most employers will take the steps to get the claim filed. The insurer will likely want evidence of your injury or illness, evidence of the severity of the condition, and evidence that the cause was work related. Because of this, you may not have them sign off immediately on your claim, and instead, you may have several more steps before you are compensated.
Not surprisingly, many employers and insurance companies are not overly enthusiastic about paying out claims. They are also not going to just take everyone’s word about their injuries as irrefutable proof that it exists and resulted from their job. One of the checks they employ is an exam with the doctor of their choice. This examiner is somewhat ironically referred to as the Independent Medical Examiner (IME). Insurer’s typically use a list of doctors, and the doctors know that if the results of their report lean more favorably to the insurer, then the insurer will continue to use them for conducting workers’ compensation related medical exams. However, failure to cooperate with the IME is not advised as it might be grounds for dismissing an individual’s claim. At the same time, there is no need to be overly forthcoming with voluntary information since there is a good chance that this person is biased in the insurer’s favor.
In certain states, individuals applying for workers’ compensation are also required to see an additional physician for what is termed an impartial medical examination. These doctors are selected because they do not seem to show any evidence of being biased towards claimants, nor do they show evidence of being biased towards insurers. In places where these exams are used they will often have a lot of sway over the outcome of a claim.
A Hearing or Hearings
States will hold some form of a hearing, or sometimes multiple hearings in which either side may argue their case regarding the injury or illness suffered by the claimant. The hearing is where many questions regarding the case will be addressed. For instance, the causality of the injury might come up, with the insurer arguing that the injury was somehow unrelated to work. For example if the claimant suffered a back injury, but medical records indicate a long history of back problems, the insurer might argue the claimant’s injury was an old one. Additional issues that might be argued include whether the medical treatment was necessary, and the severity of the injury the claimant suffered.
It is fairly common for workers’ compensation claimants to face some push back from insurers, making the process somewhat frustrating and stressful. If you were injured at work and filing a claim, you should consider contacting an experienced attorney to discuss your claim.
Contact Stern Law, PLLC for A Free Consultation
At Stern Law, PLLC, we have compassionate and caring attorneys ready to work with you in order to find the best strategy for seeking compensation for your job related injuries. Contact Stern Law, PLLC today at (844) 808-7529 for a free consolation with an experienced attorney.