The prospect of going through the process of a workers’ compensation claim in the US can leave your head spinning. Understanding each stage of the claims process and what to expect will empower you toward receiving your deserved benefits. The below services are only available in the US and do not apply to Malta.

What is workers' compensation?

Workers' compensation is a State-mandated insurance programme that aims to compensate workers for work-related injuries, illnesses, or diseases. Financial awards may cover medical care, lost wages, and disability.

Why is it Important?

Workers' compensation ensures employees are financially supported during their recovery period. Company owners get protection from liability lawsuits for workplace injuries.

Key points

• Coverage varies by state.
• Benefits tend to include medical coverage, rehabilitation costs, and a percentage of lost wages.
• Compensation is awarded under a “no-fault system,” which means that benefits are provided regardless of who was at fault.

Step #1 – Report your injury

Take action right away

If a workplace injury occurs, most states require that the worker reports the injury to the employer within the minimum deadline of a few days or a maximum of one month.

Documentation

If you’re injured, explain how, when, and where the injury occurred. Keep detailed documents to prove your claim.

Employers' responsibility

When you report your injury, your employer is supposed to furnish you with all the relevant forms and advise you how to file for workers' compensation.

Key Points

• Report the injury right away.
• Keep good records.
• Follow your employer's reporting procedures.

Step #2 – Get immediate medical attention

This should be step one if it’s a severe injury. Get medical care promptly, even if you don't think the injury is severe. Early treatment decreases the chance of complications and proves the injury happened.

Authorised healthcare providers

In some states, you may have to go to a doctor chosen by your employer or the company that pays your benefits. See your state's regulations.

Follow up appointments and care

Follow your doctor's advice and commit to follow-up appointments. Ignoring advice from your physician could adversely affect your compensation claim.

Key points

• Get medical attention right away.
• Use licensed health care providers.
• Take treatments exactly as prescribed by your doctor.

Step #3 – Submitting your workers compensation claim

Fill out the forms

Complete the necessary workers' compensation claim forms. These typically include an employee's claim form and an employer's injury report.

Submission

Submit these forms to your employer and the workers' compensation insurance carrier; keep a copy for yourself.

Deadlines

Protect all necessary filing requirements. Failure to meet filing requirements may lead to the rejection of your claim.

Key points

• All forms should be completed accurately.
• Submit forms promptly.
• Keep copies for your own reference.

Step #4 – Awaiting the decision on your claim

Initial review

Your claim is taken up by the insurance carrier for assessment. It may amount to investigation of your injury/injuries and scrutiny of your medical records.

Approval or denial of your claim

After receiving your claim, insurance carriers may or may not accept it. You may receive approval or a written denial.

Appeal procedure

If your claim is denied, you have the right to appeal. The appeal process depends on the state where you live, but typically, it involves a hearing before a workers' comp judge.

Key points

• Wait for the insurance carrier's decision.
• Understand your right to appeal.
• Appeal if you feel you have a strong case.

Step #5 Understanding the benefits available to you

Claim approval entitles you to the following financial windfalls.

Medical Benefits – Payment for proven medical services, treatments, and restoration procedures.

Temporary Disability Benefits – Payment for lost wages.

Permanent Disability Benefits – Compensation for permanent disabilities.

Vocational Rehabilitation – Help with training for a new job if you can't return to your old vocation.

Receiving your payment

Benefits will usually be paid at regular intervals such as weekly or bi-weekly. Ask questions and ask who the contact person is at the insurance company regarding payments.

Key points

• Know what benefits are offered.
• Take note of the payment schedule.
• Communicate with an insurance company when there are arrears in payments.

Step #6 – Getting back to work

Light duty

Should your doctor medically release you to light, restricted work, your employer may have a job that meets your physical limitations.

Full duty

After full recovery, you're free to get back to regular duties. Provide your employer with a return to work note from the doctor indicating that you have a clean bill of health.

Employer's responsibility

Your employer is required by law to provide reasonable accommodation to assist you in returning to work.

Key points

• Inform your employer about your return to work.
• Follow the advice from your doctor.
• Know your rights when it comes to workplace accommodations.

Step #7 – Conflict management

Dealing with common disputes

Disputes may revolve around the extent of your injury, the type of benefit you’re entitled to, or the duration you remain off work. Knowing your rights is key to settling these disputes.

Mediation

Many states offer mediation services in which both sides can reach an agreement without progressing to formal hearings. Mediation generally is a more expedited and less confrontational method of obtaining the desired result.

Legal representation

Contact an attorney specializing in WC claims if there are major disputes. Your lawyer defends your rights, collects all relevant evidence, and represents you in hearings.

Key points

• Watch for potential conflict issues.
• Try a mediation service.
• Consider legal representation for complex cases.

Step #8 – Know your rights

Employee rights

You have the right to:

• Get treatment and compensation for your injuries.
• Recover lost earnings.
• Return to work with reasonable accommodation.
• Appeal a denied claim.

Employee responsibilities

You’re responsible for the following:

• Promptly reporting the injury.
• Following medical advice.
• Keeping all medical appointments.
• Communicating with the employer and insurance carrier.

Key takeaways

• Know your rights pertaining to your situation.

Step #9 – Long-term permanent disability

If your injury results in permanent disability, you’re eligible for long-term benefits. These benefits allow for continued support at a time when you can’t return to work, or you can only work in a limited capacity.

Vocational rehab

In the case that you’re not able to return to work at the previous level of responsibility, vocational rehabilitation services may assist and guide you to starting a new career by offering services that include job training, resume assistance, and job placement.

Key points

• Understand what permanent total disability implies.
• Be sure to use vocational rehabilitation services as needed.

Wrapping up

The workers' compensation claims process has various stages. Knowing your rights and obligations helps you handle your claim. Don’t hesitate to hire a qualified attorney if you need assistance navigating the process.