9 Tips and Reminders When Making a Workers' Comp Claim
Nobody wants to get injured or get sick. It's painful. Sometimes, it can be very costly.
But injuries and illness sometimes just happen – so, it can happen at work. You accidentally fell from the roof while working on a house. Or you develop this syndrome called the Carpal Tunnel Syndrome because typing is the main responsibility of your job.
Or you just happen to fell off your office chair and broke your arm and back.
Injuries and accidents happen sometimes, but when it happens at work, it's possible that you can get compensated for the injury you got – this is possible through the workers' compensation system.
What is Workers' Compensation?
In case you haven't heard of it yet, workers' compensation is a form of insurance specifically designed to help employers when compensating their employees whenever they get injured at work.
Workers' compensation is required in most states, and in fact, many employers even obtain more workers' compensation insurance than what is required by their state. In other words, your employer or company most likely has a workers' comp insurance at hand.
On the part of the employee (you), you can claim for workers' compensation whenever you get injured at work. As long as the injury or illness happened at work (or primarily because of your work), that is almost always under the scope of workers' compensation.
When claiming your workers' compensation, it's not just as simple as filing paperwork. There are instances where workers' comp claims are denied for a variety of reasons.
So, how can you make sure that yours won't be denied? What are some tips and reminders when claiming for workers' comp? This article will try to answer that. Keep in mind that this may not make your case 100% guaranteed, but it will maximize the potential of your case – in some cases, workers' comp claim is denied simply because the employee missed a few requirements. We'll talk more about that below.
So, without further ado, here are the 9 tips and reminders when making a workers' comp claim.
1. Be sure you are eligible for workers' comp
Not all workers are eligible for workers' compensation. For instance, independent contractors (such as freelancers), volunteers and part-time domestic workers (such as maids and nannies) are not covered by workers' compensation.
Usually, the workers who are covered by workers' compensation are those who are traditionally classified as an employee – workers who are entitled to receive traditional employee benefits, something that "non-traditional" employees (like freelancers and volunteers) arent' often entitled to have.
If you are classified as the "traditional" employee, then you're almost always eligible for workers' compensation.
2. Report immediately after the incident (and report to the right person!)
If you broke your back after falling off your office chair, don't just complain to your co-worker, who probably just wants to go home and call it a day. He (or she) may sympathize with you, but he can't do anything more about it.
Or he probably just doesn't care at all. But don't worry, someone will care – your supervisor.
Report to your supervisor. Or maybe, go to your HR department and report your injury. Whoever is in charge of such cases regarding injury, go to that person or office and report your case to them. This is your first step when claiming your workers' comp – report your injury.
And yes, report immediately! Do you know that some workers' comp claim is denied simply because the case isn't reported in a timely manner?
So, report to the right person – your supervisor, employer, to the HR department, whichever and whoever is in charge – and report as soon as possible.
3. Go to the medical provider your employer told you to go
If your case is non-emergency, your employer will most likely tell you which doctor or hospital to go to. If you have a different hospital or doctor in mind (or if the employer didn't tell you which to go to), tell your employer about it. In the mind, be sure you both agree about which medical provider you should seek medical attention too.
In case it's an emergency, just let the ambulance take you to the nearest medical provider.
4. Notify your medical provider that the injury is work-related
This is to let them know that your employer will pay the bills for your medical treatment. If you didn't tell them, they will charge the bill to you. Be sure that the medical provider you went to is the one you and your employer agreed to go (unless it's an emergency). Remember point #3.
Also, be sure that the medical provider is authorized in handling workers' comp cases.
5. Your medical records should cover everything about your injury
Sometimes, your injury may take two or more body parts – for instance, breaking your back and arm after falling from your chair or roof you're working on. If you don't include one of them, they won't be shouldered by your workers' comp benefits – hence you'll be partly paying for your injury.
6. Your employer (mostly) cannot deny your workers' comp claim because it's your fault
Workers' compensation is a no-fault system, meaning you can claim it regardless of who's at fault for your injury – whether it's your employer, you or no one at all.
However, this does not mean you can be very reckless and still claim for workers' comp. In these cases, your claim could be denied. Take the next point below as an example.
7. Keep illegal substances out of your body
In general, simply be sober while at work. Don't drink and take illegal substances while at work. If you are under the influence of alcohol or illegal substances while you got injured, your claim is almost automatically denied.
Although workers' comp is a no-fault system, it does not mean that you can be reckless and still be covered by it (the same is with your employer).
8. Never attempt to fraud your case
If you're thinking of faking an injury to claim for workers' comp, then please don't. I won't even tell you to reconsider – never ever do it. There are two reasons for that.
The first one is obvious – fraud can mean jail time. Attempting to defraud the workers' compensation system usually meant high penalties and will even land you to jail.
The second, and less obvious, the reason is – employers and insurance companies usually take the effort to ensure that your claim is true and not an attempted fraud. This is simply because it's an expense on their part – it hurts to pay for something that turns out to be a lie.
So, they'll do surveillance on you. They will make home visits to see if you're really sick. They will do what they can to validate your claims.
In other words, fraud is almost always caught. You can't just hide with it. So, never attempt to fraud your case.
Just so you know, the penalty for fraud is also high for your employer or any third party involved (such as your medical provider, an insurance company or even your lawyer).
9. Attorneys are not necessarily required, but they can be helpful
Attorneys are not necessarily required because workers' compensation is specifically designed to streamline the process for employees when claiming their compensation benefits. Workers' compensation is unlike other legal processes – such as suing someone or filing for bankruptcy – where having an attorney is either required or highly recommended.
But, although attorneys are not required, they are very helpful. In cases where your claim is denied (and you believe it shouldn't be denied), an attorney may be needed when standing up for your appeal.
You can also hire a workers' compensation attorney if you simply want someone to help you with the procedure.
If you decide to hire an attorney, there might be workers' compensation attorney near you. A right workers' compensation attorney will teach you about workers' comp and guide you in the processes.