Getting injured on the job certainly makes for a bad day. Even though you may know you’re covered by your employer’s workers’ compensation insurance, you may be confused as to what to do first. On-the-job injuries can sure be chaotic, and not following guidelines can get your claim denied. Here’s how to get the benefits you need while maintaining all your rights in a claim.
1. Get Medical Attention
Before any paperwork is completed, an injured worker has the right to immediate medical attention. This is paramount to preventing an injury from becoming worse or leading to death. Immediate medical attention may include first aid treatment, calling an ambulance, going to the emergency room, and having emergency procedures performed to address the injury.
Every state encourages employers to help injured workers get medical attention right away. However, laws vary by state, and some create stipulations that must be followed for injured employees to receive their workers’ comp benefits. One such state is South Carolina, where employers have the right to choose the doctor an injured worker goes to for treatment. The injured employee can decide to go to another doctor, but that may mean the employer isn’t liable for the cost.
2. Report Injury to Employer
Most states require you to report a workplace injury or illness to your employer as soon as possible and set a deadline that may impact your benefits if missed. The deadline is usually between seven and 30 days from the date of the injury or diagnosis of an occupational disease, depending on the state.
You should provide a written account of your injury to document it properly. Your employer may have a system in place for reporting workplace injuries that includes a form where you can list key details, such as:
- Date, time, and location of the incident
- Circumstances leading up to the injury
- Type and extent of the injury
- Witness statements
If your employer does not have a formal reporting process, then you may want to send this information to your employer by email or letter. However you send it, be sure to keep a dated copy for yourself.
Employers should not suggest that you use your own health insurance to pay for workplace injuries. The purpose of workers’ compensation is to take care of your expenses if you’re injured on the job, so most health insurance policies exclude these costs. If your provider asks for your insurance card, be sure to tell them that this is a work-related injury.
Please note: Just because an injury happens at work doesn’t mean it’s covered by workers’ compensation. Injuries are only compensable if they stem from your employment. That said, you should still report all injuries to your supervisor. This ensures you both meet any reporting deadlines while also helping the business improve safety.
3. Fill Out Required Paperwork
In many states, your employer initiates the claim process by submitting a form, often called the First Report of Injury, to the state agency in charge of workers’ compensation. However, this isn’t the only paperwork that a workplace injury might generate. The state may also require you to:
- Complete an incident report or employees first report of injury
- Submit a notice of a workers’ comp claim
- Sign up for your state’s workers’ compensation online portal
Plus, your employer and your employer’s insurer will likely have forms that you need to complete, like a release of medical records.
Injured workers get a lot of correspondence during the course of a claim to make sure things are getting processed. You want to stay on top of this to prevent any delays. Most requests for information have a deadline associated with keeping your claim open and benefits coming. Don’t rely on doctors to get the information to the insurance carrier in a timely fashion. Follow up and pick up paperwork when possible to make sure it is turned in on time and to the right department.
4. Keep Records
If your claim is denied or your benefits are terminated early, you may need to file an appeal. One way to prepare for this possibility is to create a file to maintain a record of your claim. Put all correspondence and copies of any forms you’ve provided to the insurance carrier, your employer, or the state in this file as well as a record of your doctor visits and bills.
You often have 30 days to file an appeal if your claim is denied or terminated, but this varies from state to state. Typically, the denial letter outlines the appeal process, so be sure to check it for the time frame, required forms, and contact information for the appeals board. If your denial letter does not provide this information, check with your state’s workers’ compensation board to get the details for a claim appeal.
5. Consider Hiring a Workers’ Comp Lawyer
While receiving workers’ comp benefits generally restricts your ability to sue your employer, you may still want to hire a lawyer for certain situations. One common example is if the insurance company offers a settlement, and you’re not sure it’s enough money. Another instance is if your claim is closed before you are ready to return to work.
Remember that employers can’t force you back to work before your doctor gives you the OK, and you have a right to return to your job after you go through the claim and rehabilitation. An attorney knows the state laws and can guide you through the proper course of action to get all the benefits you are owed.
When you’re injured on the job, it’s important to get the medical help you need quickly. You also want to start the claims process with your employer sooner than later and keep track of all the paperwork involved. You don’t want to be denied benefits because of a technicality. If you feel you are getting the runaround from your employer or their insurance carrier, contact an attorney for help.