Without workers’ comp benefits, it is often difficult to form ends meet after a piece of injury. Unfortunately, too many injured workers make simple, but costly, mistakes during the workers’ compensation claims process. If you’re injured at work, it’s important to understand your legal rights and responsibilities. Here are some practical recommendations on the way to get the foremost out of your workers’ comp claim.
1. Immediately Report Your Injury
The first thing you should do after a work injury immediately reports it to your boss. Every state requires workers to offer notice of their injuries by a particular deadline, which varies significantly by state. If you miss the deadline, you would possibly lose your right to gather workers’ comp benefits. In some states, you’ll also get to file a workers’ compensation form by a particular date so as to officially start your claim. To learn more about these requirements, read our article on filing workers’ comp claims.
2. Get Prompt Medical Treatment
You should seek medical treatment as soon as possible after your injury. Prompt medical aid can cause a quicker, fuller recovery. It also is important medical evidence in your workers’ comp claim by documenting your accident and describing your injuries and physical restrictions. If you delay in getting treatment, the insurance firm could argue that you simply weren’t as seriously injured as you say you were—or that your injury never happened in the least.
3. Consider Changing Doctors
In many nations, workers must initially treat with a doctor chosen by the insurance firm. When you treat with the insurance company’s doctor, there's a possible conflict of interest. These doctors are paid primarily by insurance companies and should not always have your best interests in mind. For example, the doctor might minimize your injuries and treatment in order that the insurance firm won’t need to pay you the maximum amount. (If you’re lucky enough to measure during a state that allows you to choose your own doctor, this usually won’t be a drag .)
Because your treating doctor will play an important role in your workers’ compensation case, you ought to switch doctors if you think that you’re not getting the simplest treatment. Each state has its own rules and procedures for changing doctors, which vary significantly. For example, there could be a waiting period before you'll switch, otherwise, you could be limited to just one change during the course of your workers’ comp claim. And, in some states, the insurance firm will select your new physician or you’ll be required to settle on from a network of approved doctors.
4. Understand Your Available Workers’ Comp Benefits
Injured workers should understand the available benefits through the workers’ comp system. While each state has its own rules for eligibility and amounts, the subsequent benefits are typically available:
- Temporary disability benefits: paid while you're off work and still recovering from your injury
- Permanent disability benefits: compensation for lasting physical impairments caused by the injury
- Medical treatment: reasonable and necessary medical aid for your injuries
- Vocational rehabilitation: job retraining and other help finding employment within your work restrictions, and
- Mileage: compensation for your visit and from doctor’s appointments and other workers’ comp-related travel.
Because insurance companies are for-profit businesses, you shouldn’t believe the adjuster to completely explain your state’s benefits system or all of the available benefits. If you've got questions, contact your state workers’ compensation agency or a workers’ comp lawyer for help.
5. Be Prepared for Your Independent Medical Examinations
Unlike a daily doctor’s appointment, an independent checkup (IME) doesn't specialize in treating your injury. Instead, the insurance firm hires a doctor to perform an examination, review your medical records, and issue a report. This report summarizes the doctor’s opinion on your diagnoses, work restrictions, and therefore the relationship between your injury and your work. Frequently, insurance companies schedule IMEs when they want to terminate or reduce your workers’ comp benefits.
If you're scheduled for an IME, you want to attend the appointment (or risk termination of your workers’ comp benefits). It’s important to organize for the IME by reviewing your medical records and anticipating tricky questions from the IME doctor. See our article on the way to steel oneself against your IME to find out more.
6. Beware of Surveillance and Private Investigators
If the insurance firm questions your credibility, it'd hire a personal investigator to follow you around. The investigator will watch your reception and publicly places—hoping to catch you doing something that contradicts your workers’ comp claim. For example, suppose you tell your doctor that you simply can’t lift quite five pounds. If surveillance footage shows you carrying boxes into your house, the insurance firm will use it to argue that you’re lying about your symptoms. However, the footage can easily be misinterpreted—the boxes could be lighter than they seem otherwise you may need to experience a significant increase in pain afterward. If you think that you're under surveillance, ask a workers’ comp lawyer about how you'll minimize the impact of surveillance footage.
7. Keep Detailed Records
It’s always in your best interest to stay copies of paperwork concerning your workers’ comp claim, including work restrictions, letters from your employer or the insurance firm, and completed forms (such as an accident report). While your doctors will create medical records documenting your treatment, work restriction slips aren't always put in your medical records. Many of those records are essential for getting your workers’ comp claim approved and paid.
8. Consider Appealing a Denial of Benefits
Insurance companies are for-profit businesses. They frequently deny legitimate workers’ compensation claims in an effort to save lots of money. However, you have the right to appeal the insurance company’s denial. Many workers who received initial denials find themselves receiving a minimum of some workers’ comp benefits after filing an appeal.
While every state features a different process and requirements, an appeal typically requires filing a written form with the state agency by a particular deadline. Once the state agency processes your appeal, a judge will typically schedule one or more hearings to assess and resolve your dispute. Because workers’ comp appeals are complicated and need extensive legal and technical knowledge, you ought to seriously consider hiring a workers’ comp lawyer at now. (For more information, read our article on workers’ comp appeals.)
9. Attend All Scheduled Legal Proceedings and Appointments
Unless you've got a workers’ comp lawyer, you want to attend every legal meeting or court date during an appeal (such as mediation, scheduling conferences, and hearings). If you are doing not appear at a scheduled legal appointment, you risk losing some or all of your benefits. Even if you've got a lawyer, you'll get to show up for a few key events (such as your deposition or an independent medical examination). If you've got to miss a meeting, it should be for an honest reason and you ought to notify the insurance firm and therefore the state agency beforehand.
10. Consider Hiring a Workers’ Comp Lawyer
You might not need a lawyer if your workers’ comp claim is extremely simple or if the insurance firm voluntarily pays your claim. However, consider hiring an experienced lawyer if the insurance company:
- Reduces or denies your benefits
- Makes a settlement offer or
- Ignores your claim or your requests for information.
It is often difficult to navigate the workers’ comp system, including when to simply accept a settlement offer and for a way much. A lawyer can properly value your claim, negotiate with the insurance firm, and represent you in an appeal, if necessary.
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