How to File a Workers' Compensation Claim
Learn Your Rights
As an employee, your company is required by law to ensure your safety and well being at work. If they fail to do so, then they have to take care of you. The Worker Compensation system was created to relieve the strain on courts dealing with lawsuits from injured workers. The desired result is that you receive the same quality of benefits without having to hire a lawyer.
It is also illegal for an employer to punish you for reporting an injury. If you have been following company policies, and were not doing anything outside the scope of your work, you are entitled to compensation and expenses. You also have legal protections against retribution. In the US, you can look to OSHA or the Department of Labor for support if you feel you have been singled out for reporting an injury.
A good knowledge of your rights and responsibilities will help you work with your employer, instead of trying to fight them to get what you are owed. Companies know that having injured workers is not only bad for the bottom line, but it can hurt the morale of other workers too if they have to worry that they could be the next one hurt at work. An injury should be an opportunity for the business to show it cares by finding a solution to the problem that caused the injury. Neither the company or the employee come out ahead when there is an injury in the workplace.
Right of Privacy
Personal medical information is protected by HIPPA laws. That stands for Health Insurance Portability and Accountability Act. This ensures that your medical history and treatment are not public information for everyone in the company to know. You are entitled to share your own information as you wish, but your employer cannot tell your supervising manager, or anyone else, anything more than work restrictions and limitations, without your consent.
It would be near impossible to stop workplace rumors, and this rule applies primarily to the people who are in a job position that involves handling the data, and won't prevent people you tell willingly from sharing that information.
In addition, some of the HIPPA rules apply to storage of information. It would be negligent of your company if they left your medical file laying on a break room table, and anyone coming through could look through it. This is important because many documents have information that could be used in identity theft, such as your social security number.
Also Know Your Responsibilities
When you are injured, it is critical that you inform your employer. Laws vary by state, but if you wait too long, or an injury develops later from the first incident, you could be denied benefits. If it turns out to be nothing, you have lost nothing. In addition, your employer's policy may give them grounds to terminate you, even if they do pay the injury bill. Long term health effects will be considered a little differently, because it may take years for symptoms to develop.
A well planned company disciplinary policy will be the supporting factor for the company. The legal procedure to fire you would be based on breaking company policy, and not due to being injured. It is up to the employer to document this process, and they must be able to show they would have fired you even if you were not injured, or else they make it look like the injury was the primary motivation for their decision.
Determine if an Injury is Work Related
This is usually a responsibility of the employer and the insurance group. You can however help prove your case if you explain exactly what happened before the injury. If you were doing your job, you are almost always covered. There are cases where you might be at work, but not doing work related things. Walking to your car after work is eligible, but walking to your car to put your lunchbox away might not be covered if nobody required you to do so. This is even more so if there is a company policy that prohibits going to the parking lot during work hours without approval, and you went without telling a supervisor.
After you report an injury, if it is a major emergency, you will go to the nearest emergency treatment facility or call an ambulance. For less serious injuries, they will provide you with a list of doctors to choose from. A representative of your employer, such as your immediate supervisor, should go with you if you have to leave work. At the very least they will call ahead and let them know that it will be a work comp case.
From this point forward, you will follow the doctor's recommendations for treatment or referral to a specialist if needed.
Returning to Work
Your doctor may release you back to work right away, or he may assign you restrictions such as a lifting limit. Any task you do at least once in a regular week that you cannot do after an injury, is considered a restriction.
When restricted, you may be asked to sign an agreement with your employer. It is usually just to say you will not attempt to do anything outside your medical recommendation, to prevent further injury before you are fully healed.
Maximum Medical Improvement means you have healed either fully, or as much as it will ever heal. If your best case scenario is not as good as you were before, you may be eligible for a disability rating. Your doctor should be able to discuss your permanent limitations if there are any.
If you are given restrictions and your employer has a position they can put you in, you should accept the restricted duty position. If you decline, they may be able to cease paying benefits. You should always discuss with the treating physician before you decline the light duty work. If they agree with you, they can change your restrictions to something more appropriate. Returning to work is the best option if you are able to perform the function offered. You receive full pay, instead of only 66 2/3rds percent.
Once you are able to work unrestricted according to your medical provider, your company should move you back to your original spot, or an equivalent position.
Billing and Payments
If your company is well organized with their care centers, they should receive the bill directly. If you receive it at home, take it to your Human Resources department, or whichever person handles the claims. If you don't know who that is, your supervisor should be able to direct you. Remember, you are not required to disclose the specifics of your case to your supervisor, but they will need to know if you have work restrictions, and what the guidelines of your treatment are.
The company will be responsible for all expenses that stem from the work injury. This can include mileage according to the guidelines of your state. Often there is a minimum distance before you receive personal vehicle mileage reimbursement, such as 15 miles round trip.
Lost time has two thresholds for receiving your paycheck. In my state, you start getting paid after your 8th missed day, at a rate of 66.6% of your average weekly wage. After 14 days, they have to back pay you for the first week too.
Your boss can't make you spend vacation days for a work injury. If they ask you to do this, chances are they are trying to keep the injury off the record as lost time. If you are able, get any of these requests in email form so you have a record. They will help you if you end up having to hire a lawyer.
Future Pain or Issues
Once you report an injury and receive treatment, any future injury that could be attributed to the first injury can be added to that claim. An injury that never fully heals will always be covered under work comp, such as having to take medications for the rest of your life. Good documentation from the medical treatment is vital to establish the incidents as being related.