December 26, 2024 | Workers' compensation

Do you ever think ‘I’m probably going to suffer an injury today,’ while getting ready to go into work? Going to work for many is a mundane task. This is true even for those that work in environments that are inherently dangerous such as construction sites. However, when an injury occurs, it can have a major impact not just on your physical health but also your income and finances. The workers’ compensation system is designed to provide a financial cushion for injured workers. It is meant to ensure that injured workers access the medical treatment they require and are compensated for income lost as a result of the injury.

Below, we take a look at the workers’ compensation claims process and the steps along the way. We take the example of a worker that has injured their back lifting something heavy at work.

I Hurt My Back at Work – The Workers’ Compensation Claims Process

Step 1: Report the Injury

The first step in the claims process is to report the injury to your employer. Most states require employees to notify their employers of their injuries within a specific time frame (often 30 days or less). If you fail to report your injury within the allotted time, you may forfeit your right to claim workers’ compensation benefits. It is therefore important to take the step immediately you realize your back is injured or as soon as you are able.

The report should provide as many details of the accident as possible including when it occurred, where and how. It should also include information about who was present at the time the injury occurred.

Step 2: Seek medical attention

Your health and safety should be your top priority. If the injury isn’t severe, you may opt to receive first-aid on-site and then seek medical attention from medical professionals later. If your injury is severe, call emergency services and get treatment at a medical facility.

You should note that how medical treatment should be administered for work-related injuries is different from other types of injuries. Some states or employers will require you to see a healthcare professional authorized by the employer or their insurance carrier. Be sure to clarify this with your employer.

Receiving immediate medical treatment is important not just for your health but also for documentation of your condition. A diagnosis and record of treatments will be key evidence in your claim. Be sure to keep a record of any expenses related to the treatment of your injury.

Step 3: Filing the Workers’ Compensation Claim

When you report your injury to your employer, your employer will initiate the claims process by informing their insurance carrier of the injury. Your employer should provide you with the necessary forms to file your workers’ compensation claim. The completed forms should be submitted to your insurance carrier for approval of the claim.

Employers aren’t always cooperative when it comes to workers’ compensation claims. Your employer may even attempt to discourage you from filing a claim. It is therefore important to consult with a workers’ compensation attorney and learn about your rights and options.

Step 4: Approval or Denial of the Claim

When the insurance company receives the completed forms from your employer, they will begin to investigate your claim. This often involves a review of your medical records, interviews with witnesses as well as an examination of the circumstances surrounding your injury. At this stage, it is not uncommon for insurers to look for reasons to deny or minimize your claim. For this reason, it is a good idea to have an experienced attorney representing you.

Once the investigation is complete, your claim will either be approved or denied. If your claim is approved, you should start receiving benefits. If it is denied, you have the right to appeal the decision.

Step 5: Appealing a denied claim

Claims can be denied for various reasons including insufficient evidence, missing information, a dispute on whether the injury is work related. The latter is especially true in the case of chronic injuries or illnesses. If your back injury is a result of repetitive strain, or became worse as a result of your tasks at work, the insurance company can claim that it isn’t work related.

If your claim has been denied, this isn’t the end of the road. There’s still hope. You can appeal the denial. It helps to have an attorney guiding you through this process. It often involves:

• Filing an appeal with the state’s workers’ compensation board
• Attending a mediation session or a hearing to resolve the dispute
• Presenting evidence to support your appeal.

Step 6: Return to work

After recovery, you may return to work. If you are fully recovered, you may return to your previous position. However, this should be done only after approval by your healthcare provider. If your injuries resulted in a disability that prevents you from returning to the same job or position, your employer may assign you to a more appropriate position or you may go through vocational training to gain skills in order to pursue a different career path.

Navigating the workers’ compensation system can be overwhelming. This is especially true when dealing with the stress and pain of an injury. The attorneys at High & Younes LLC can help you secure your benefits. Contact us to schedule free consultation and get started.

Workers Comp Insurance Claims Attorneys