What Do You Have To Do To File a Workers’ Compensation Case?

What Do You Have To Do To File a Workers’ Compensation Case?

Workers’ compensation is a no-fault system that provides benefits to employees for work-related injuries, illnesses, and diseases. Most employers are required to maintain this insurance, and in exchange, employees forfeit the right to sue their employers after workplace accidents

If you were injured in the course of your employment, you likely have a valid workers’ compensation claim. However, to protect your right to fair benefits, you must follow certain requirements, which vary from state to state and among employers.

Below, we provide a general overview of what you should do to file a workers’ compensation claim. If you have questions or need legal advice, contact a local workers’ compensation lawyer for guidance. 

Notify Your Employer of Your Injury Within the Applicable Deadline

One of the first steps in a workers’ compensation matter is to give proper notice to your employer. You must explain the nature of your injury and that it occurred while performing job duties, and provide the date and time it happened.

All states provide different deadlines for reporting a work-related injury or illness to an employer. 

For example, in Pennsylvania, you must report to your employer within 120 days of the accident or injury, or your claim for compensation will be denied. However, you should notify your employer within 21 days so that you’ll receive full benefits from the date of injury. Otherwise, you’ll likely receive benefits starting on the date you provided notice.

Other states, like Georgia, provide a 30-day deadline to report an occupational injury to your employer. If you fail to provide timely notice, you may lose the right to recover workers’ compensation benefits. 

Promptly See an Approved Healthcare Provider and Follow the Treatment Plan

It’s essential that you seek immediate medical attention after sustaining an on-the-job injury. For one, you want to protect your health, but you also want to start a record documenting that the injury occurred in the scope of your employment. Your medical record will be a crucial piece of evidence to support your workers’ comp claim. 

Most employers and their workers’ compensation insurance carriers provide a list of approved healthcare providers. Failure to visit an approved medical professional may result in a denial of benefits in some – but not all – cases. 

Additionally, you must follow your physician’s recommendations and treatment plan. Failure to follow through or any deviations from their medical advice could result in a denial of your claim. 

Keep Records and Gather Evidence

Workers’ compensation benefits typically pay for reasonable and necessary medical care and expenses and a portion of your lost wages (disability benefits). 

You should maintain thorough records throughout your recovery period in case your claim is denied or you aren’t offered full benefits. Anytime you visit a medical provider, keep any statements they provide. If you purchase over-the-counter medications or medical supplies, keep your receipts. 

This type of documentation will help if you need to resolve the claim through alternative dispute resolution or if you appeal a decision. 

File Your Workers’ Compensation Claim With the Appropriate State Agency

Each state has an agency that handles workers’ compensation claims. For example, in PA, the Pennsylvania Department of Labor & Industry’s Bureau of Workers’ Compensation enforces and administers these claims. 

After you report your injury to your employer, they must immediately notify their insurer and file a First Report of Injury (FROI) with the Bureau within seven days to establish a claim and start the process. The insurance company then has 21 days to approve or deny the claim. 

If your employer or their insurer accepts liability, you’ll start receiving benefits.

If your workers’ comp claim is denied, you can file a Claim Petition for help resolving the dispute. You may need to attend mediation, a hearing, or a conference, where a workers’ compensation judge will help you and your employer settle the case. If alternative dispute resolution is unsuccessful, you can file an appeal with the Workers’ Compensation Appeal Board.

If you need to appeal a workers’ compensation decision, it’s best to hire an experienced attorney for assistance.

A Workers’ Compensation Lawyer Can Help With All Aspects of Your Claim

Whether you’re just starting the workers’ compensation claims process, you received a settlement offer, or your request was denied, a lawyer can help. A workers’ compensation attorney knows the law and how to navigate the procedures involved. They’ll ensure you receive the benefits you’re entitled to and protect your legal rights.