Taking the right steps with the help of a workers’ compensation claim checklist may help you successfully recover compensation after sustaining a work injury. Here, you’ll learn about the process and what you can expect when filing a claim with workers’ comp insurance companies.
What Types of Workers’ Comp Benefits Can You Recover?
If you or a loved one sustains a work-related injury or illness, it may be possible to recover various benefits through a workers’ compensation claim. Most employers must carry a certain amount of workers’ comp insurance. Exceptions apply to employers who hire independent contractors on 1099s.
If you want to seek compensation for a work injury, the following are some of the benefits that a workers’ comp claim may cover:
When opening a workers’ compensation case, you may seek compensation for medical care to treat injuries or illnesses.
Some examples of the medical bills that these claims cover include:
- Emergency care and hospital stays
- Doctor’s appointments
- Surgical procedures
- Physical therapy and occupational rehabilitation
- Medical devices and medication
Workers’ compensation may also cover lost income if injuries prevent workers from working or limit their ability to work. It won’t cover the entirety of the employee’s lost income, but it will cover a percentage to help you recover.
In certain states, such as Illinois, injured workers can recover different types of wage replacement benefits depending on the extent of their disability. Specifically, workers may receive benefits based on whether they qualify for temporary partial disability, temporary total disability, permanent partial disability, or permanent total disability benefits.
Here is a breakdown of each of these benefits:
- Temporary partial disability (TPD) — If a worker receives TPD benefits, he or she is capable of working on a part-time or full-time basis, but in a lesser capacity than he or she would typically be able to work. TPD coverage pays 66.6% of the difference between what you earned prior to your injury and what you earn following the injury.
- Temporary total disability (TTD) — A worker will qualify for TTD benefits if he or she is entirely unable to work for a certain period. Like TPD benefits, TTD benefits cover a specific percentage—66.6%—of lost wages, only this percentage covers a portion of the worker’s average weekly earnings.
- Permanent partial disability (PPD) — Injured workers may also be able to recover PPD benefits. There are two main kinds of PPD benefits, including initial compensation and increased benefits. The initial compensation equals the worker’s disability multiplied by 450 weeks. Additionally, workers may recover increased benefits if they have either not returned to work or are working and earning less than what they earned from an employer before the injury. However, increased benefits won’t apply if the worker quits his or her job for a reason unrelated to the injury.
- Permanent total disability (PTD) — Workers who sustain permanent total disabilities will be unable to return to work, in which cases they may qualify for PTD benefits that cover 66.6% of their average weekly earnings for the remainder of their lives.
Workers may be unable to return to the same job they had before their injuries, often when workers are unable to perform the same level of activity the job demands of them.
Your state’s workers’ compensation commission may be able to assist you with finding employment with another employer if you are unable to return to work with your previous employer.
If an employee dies because of his or her work-related injury or illness, the victim’s family may be able to recover death benefits through a workers’ comp claim. Typically, the victim’s immediate family and dependents would qualify for these benefits in the event of the worker’s death.
Death benefits cover certain expenses pertaining to the worker’s death, including funeral and burial expenses, along with the costs of medical care leading up to the victim’s death. These benefits may also cover additional expenses resulting from the death.
If you need help determining what benefits you may be able to recover through a workers’ comp claim, an experienced workers’ compensation
Steps to Take After a Work Injury
Following a work-related injury, it’s important to take the right steps to build a workers’ compensation case and recover a full settlement. To help you increase your chances of succeeding with a claim, take the following steps in this workers’ compensation checklist:
Seek Medical Treatment
If your injuries are serious, seek medical attention as soon as possible. You may need to visit the hospital for emergency care, which will help you recover and generate medical records proving the nature and cause of your injuries.
Even if you don’t require immediate treatment, you should seek medical attention soon after your injury. If you wait too long to seek treatment, it could be challenging to prove that a work-related incident caused the injury.
If you do need to seek treatment, your employer’s workers’ comp insurance may require you to see a designated physician. However, you may seek a second opinion from an independent medical professional if needed. This expert may be able to counter or support the other doctor’s diagnosis.
Report the Injury
Unless you require immediate medical care, the first step to take after a work-related injury is to report the injury to your employer. Regardless of the specific details involved in your incident, it’s necessary to report your injury as soon as possible to begin the workers’ comp claims process.
When you notify your employer, a supervisor or manager should provide you with details about how to file a claim. He or she should provide you with any necessary paperwork to help formally file a claim with the insurer.
Remember, you likely only have a limited amount of time to report your injury to employers before you’re unable to file a workers’ comp claim. Typically, you’ll have around a month to a month and a half to report your injury, but this time limit will vary from state to state.
File the Necessary Paperwork
Once your employer gives you the forms you need to file a claim, the next step is to complete this paperwork. Specifically, you’ll file this with your state’s workers’ compensation board, which should be able to relay and answer questions about workers’ compensation facts and the benefits available to you.
Gather Sufficient Evidence to Support Your Claim
When filing a workers’ compensation claim, you should collect as much evidence as you can to help prove the extent of your injury and the root cause.
There are many types of evidence you can collect for your claim, including:
- Photos of your injuries and the scene of the accident. If possible, take photos or record footage of the scene immediately after the accident, which may help capture the element that caused your injuries. However, you may be able to return to the scene to capture this footage if needed.
- Witness statements from people present at the scene of the accident, including other colleagues or pedestrians. These individuals may be able to provide official statements that support your claim.
- All medical records and other relevant documentation. If you visit your doctor regularly and seek treatment, medical records will further help prove the extent of your injury. You can also collect other supporting documentation.
- Incident reports filed with employers that detail the accident and how it occurred, along with the resulting injuries.
Adhere to Your Doctor’s Treatment Plan
Once you’ve sought treatment from a medical professional, it’s important to keep appointments and stick with the doctor’s treatment plan. Doing so will help you begin the recovery process, eventually helping you make a full medical recovery. It will also help you gather more medical records to help prove your claim as you seek full compensation for medical bills.
If you have an issue with your doctor’s current treatment plan, speak with your doctor before making any changes. He or she may work with you to develop a more suitable treatment plan for you based on your needs. You can then begin collecting documentation once you formally make this change without potentially compromising your health or workers’ compensation case.
Keep Your Employer Up to Date
As you recover and seek compensation, notify your employer of your progress. Providing your employer with doctor’s notes and other documentation can help explain why you’re unable to return to work if you’re temporarily or permanently disabled.
Return to Work When Possible
After finalizing your workers’ compensation claim, you may be able to return to work if your condition allows for it. You’ll be able to detail to your employer what work you’re able to complete based on your condition.
Contact a Workers’ Compensation Attorney
Another important step to take is to contact a workers’ comp lawyer when necessary. While you may not need legal help with a workers’ comp claim, it’s often beneficial to speak with an experienced lawyer to discuss your options.
For example, you might be unsure about what kinds of compensation you can recover with your claim. An attorney can indicate what type of settlement you can expect based on the details of your case.
An attorney may also be able to help you prepare to file a claim if you’re not sure what you’ll need to begin the claims process.
What to Do If Your Claim Is Denied
In some cases, employers or insurance companies may deny workers’ compensation claims. There are multiple reasons why these parties might deny your claim, depending on the circumstances. You might wonder how often workers’ compensation claims are denied, and the answer is that it can frequently happen for numerous reasons.
One reason for a claim denial is the failure to report the injury to the employer or file the necessary paperwork on time. Other reasons could include: the claimant isn’t an actual employee of the company, sustained the injury before the work incident or otherwise developed outside the incident, or failed to adhere to his or her doctor’s treatment plan. Sometimes, employers or insurers may also deny claims if claimants sustained injuries that didn’t require any treatment.
In the event of a worker’s compensation claim denial, you may be able to appeal the decision.
Going Through the Appeals Process
If you decide to appeal a workers’ comp claim denial, you will go through your state’s workers’ compensation appeals board. However, this process can vary depending on the state. In some states, you might need to appeal in front of an administrative law judge, giving you the chance to prove your claim with various pieces of evidence. In other cases, you might need to appeal with your state’s labor department.
The employer or insurer should provide you with a reason for the denial of your claim, which you should review to ensure you’re able to appeal the decision. If you don’t believe there was a valid reason to deny your claim, you may proceed with the appeals process.
Before beginning the appeals process, you may benefit from speaking with a workers’ comp attorney. An attorney can review the denial letter and help further confirm whether you have the chance to succeed with an appeal.
When going forward with an appeal, you should collect as much evidence as you can to support your appeal. This will help increase your chances of successfully reversing the decision.
Take the Right Steps to File a Workers’ Comp Claim
With the right approach to your workers’ compensation case, you may be able to recover compensation to cover medical expenses and lost wages, among other expenses pertaining to your case, such as rehabilitation and death benefits.
By taking the appropriate steps discussed in this workers’ compensation claim checklist, you may successfully prove that an injury was work-related and maximize your chances of receiving total compensation.