Transcript: Learning the Workers’ Compensation Claims Process
You’ve been hurt at work and you know you’re going to miss a significant period of time. You’re worried about paying your bills, you’re worried about taking care of your family, and you want to know what the law provides for you.
The most important thing, initially, is just reporting your injury to your employer
Under the law, to receive all the benefits that you’re entitled to, you must report your injury within twenty days, and if you do not report your injury within 120 days, then your claim has expired and it goes away. The reason it’s important to report your injury to the employer, even if you think it’s a minor injury, is sometimes down the road a minor injury turns into more than we think it will be.
- To notify your employer of a work injury, you do not need to fill out a specific form—it does not have to be in writing—you simply have to tell your boss or supervisory person “I’ve been hurt at work and I believe I’m missing time because I’ve been hurt at work.”
- Your employer is required to tell you in writing within twenty days of the injury if they’re going to accept the claim or deny the claim and pay workers’ compensation.
The second thing you need to do is see a doctor
In order to receive benefits under the Worker’s Compensation Act, you need to be able to prove medically the reasons why you’re missing time from work. As far as medical treatment goes, you must treat with doctors on the employer’s list of panel doctors, if the employer has properly set up the list, and you must treat with those doctors for up to 90 days. If your employer doesn’t have a list of doctors or is unable to provide you with the names of doctors to see, then you’re allowed to see whatever doctor you want.
- Many times when you’re hurt at work, the employer will assign a Nurse Case Manager to your claim.
- The Nurse Case Manager will attend your doctor’s visits and try to coordinate your care. Sometimes, these nurses are very friendly people. Sometimes they’re not. But in every situation, you should not view them as your friend.
- They are there to make sure that your employer pays the least amount of money or the least amount of compensation that they can.
The Nurse Case Manager will try to direct your care to cheaper options; the Nurse Case Manager will try to get your doctors to say that you’re ready to go back to work—sometimes appropriately, but sometimes sooner than you should.
It’s really the doctors who should be directing your care—not nurses and not an insurance company.
Many people will ask me “If I have insurance and if I have another way to be paid—whether my boss is paying me sick time or I’m getting some sort of a disability policy—do I even need to report the injury?”
The answer is almost always “Yes.”
Under the Workers’ Compensation Act, the benefits are available to you are wage-loss benefits—as long as you are missing time from your job as a result of the injury—and medical benefits until you’re 100% better.
The medical benefits aren’t tied to employment. They’re not tied to paying your premium or anything like that. Basically, you have the right to medical treatment under the Workers’ Compensation Act forever, until you’re 100% better, and that’s a superior right than you will receive from any health insurance.
There are two types of work comp benefits that apply to almost every case
One is medical, the second is wage loss, and the two rights are separate from each other. You receive wage-loss benefits as long as your work injury is preventing you from working, and you receive medical benefits until you’re 100% better.
So you can be working and you can not have a wage loss and still be entitled to medical benefits. So, the right medical benefits can extend much longer than the right to wage-loss benefits.
When you’ve been injured, solutions start here. At Hall and Copetas, we do our best to give our clients a voice in court. It’s your voice, so be heard.