Workers’ compensation is a mandatory insurance in most states. If you get injured at your workplace, you may be eligible to receive equitable compensation to cover any expenses and losses you might experience.

However, filing for workers’ compensation can be a complex legal process. So, we asked attorney Ed Bernstein from Edward & Bernstein to clarify the laws and regulations concerning workers’ compensation and all factors involved in filing one. Here’s what he had to say:

Understanding Workers’ Compensation

Workers’ compensation is insurance generally provided by your employer that benefits you if you succumb to a job-related injury or illness. 

It can cover your medical expenses, doctor’s fees, and lost wages. This insurance also helps protect employers from costly lawsuits you may raise due to your injuries.

While workers’ compensation is mandatory in most states, its laws and regulations will differ depending on the location. Furthermore, the compensation you’ll receive depends on the severity of your injury and the time you’ll take off.

Filing for workers’ compensation can be a legally complex process. For example, you must report your injury to a doctor, who will file a Form C-4 and submit it to your employer’s insurance company for payment.

Workers’ Compensation Considerations

Once your doctor has filed the form, several factors come into play to decide the success of your claim. Let’s explore them in-depth.

1. What Does it Cover?

If your case is successful, your workers’ compensation can cover the following:

  • Medical Expenses: Including doctor’s fees, medications, and any rehabilitation costs to ensure that you receive the care you deserve and get back on your feet as soon as possible
  • Lost Wages: To ensure you’re financially covered for the period you’re off work and compensated for the income you’d receive during that period

The amount you receive depends on the severity of your injury and the time you take off work. You may also be eligible for ongoing disability payments for the rest of your life if you succumb to a disability that prevents you from working again.

Mind that the laws concerning the type and amount of payments you receive differ depending on your state, so it’s best to consult an experienced attorney before filing a claim.

2. What Are My Responsibilities When Filing a Claim?

You must report your symptoms and condition to your employer immediately. Then, seek medical care from a state- or employer-approved medical professional if you succumb to an injury at your workplace.

You must notify them that your injury was due to a workplace-related accident so they can file a Form C-4. They’ll then submit the form to your employer’s workers’ compensation insurance agency for you to receive any benefits. 

Additionally, you must comply with your employer or their insurance agency’s requests and instructions.

Your doctor has 90 days to submit the claim, but this period may differ depending on your state. Once they do, the agency has 30 days to respond via a letter indicating whether they’ll compensate you or deny your claims. You can also appeal your claim if it’s rejected.

Mind that the agency may refuse to pay some of your benefits and pay for othersthis is called a partial claim denial. So, for your claim to be successful, remember to document your injury and collect strong evidence to support it.

3. What Are Your Employer’s Responsibilities?

As an employee, you must understand that it’s your employer’s responsibility to guarantee a secure workplace environment. They are held accountable for taking appropriate measures to prevent any potential mishap or injury from occurring within their environment.

It’s also necessary for them to provide you with information regarding your rights and duties concerning workers’ compensation laws. That includes guidance on filing a claim if it becomes essential. 

Moreover, your employer must notify their insurance provider of any job-related injuries or illnesses that may occur within the workplace.

If your employer neglects the safety of their work environment or defaults on alerting about incidents, they could face severe financial sanctions. It’s also possible that you’ll have better chances of filing a successful claim against them if that’s the case.

What Is a Claim Fraud?

Your employer can commit claim fraud by misclassifying their employees or providing false information to the authorities. You can also fall into it by lying, intentionally causing your injury, or exaggerating its extent. 

Claim fraud is unfortunately common in workplaces and should be reported to the appropriate authorities if discovered, as it can harm you, your employer, and the compensation system.

4. When Do I Need an Attorney?

Filing a claim is a legally complex process that involves many complicated laws and regulations. Having an attorney by your side is a way for you to ensure proper guidance, better benefits and chances of filing a successful claim, and an expert negotiator with your employer’s insurance company.

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Last Update: March 23, 2023