Written by Avvo Staff

Filing a workers' compensation claim

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A workers' compensation claim can help you receive the funds you need to pay medical expenses and other bills after a work injury. The process starts when you file your claim, but knowing when and how to file are just as important as knowing what happens afterwards.

When to file for workers' compensation

You can file for workers' compensation if you become injured while working, or if you develop an illness related to your work.

It's best to file your workers' compensation claim as soon as possible. Any delays can harm your chances of receiving compensation.

Consulting an attorney is also a good idea if you think you have a workers compensation claim. This is especially true if you feel your employer or their insurance company might challenge your claim.

The filing process

When you file for workers' compensation, both you and your employer have responsibilities to take care of.

Responsibilities of the injured party:

  • Get immediate medical care for your condition, if required

  • Inform your employer of your work injury or illness as soon as possible (and within your state's statue of limitations)

  • Complete workers' compensation claim forms

  • Submit a claim form to your state workers' compensation agency (in some states)

  • Have an independent medical examination performed by a doctor of your employer's insurance carrier's choice

Responsibilities of your employer:

  • Distribute claim forms to you

  • Submit your claim form to the insurance carrier

  • Notify their insurance carrier once you return to work

Your right to file for workers' compensation

You have the right to file for a workers' compensation claim for any illnesses or injuries received while working or as a result of working. If your employer refuses to cooperate, call your local workers' compensation office. Its employees can speak to your employer on your behalf and remedy the problem.

You also have the right to receive compensation if you are hurt on the job or fall ill as a result of your employment. If your employer contests your claim, you can have your case heard in front of a court.

Obtaining legal representation will give you the best chance of winning your case. Most workers' compensation lawyers work on contingency, so you won't need to pay upfront. Keeping good documentation about your condition, including medical records, will also strengthen your case.

What happens after you submit your claim

Your employers' insurance carrier will assess your claim. If the carrier approves your claim, an insurance adjuster will contact you or your employer with instructions for submitting your medical bills.

If your illness or injury requires you to take extended time off work, you may also begin receiving checks to cover your lost wages until you return to work. Alternatively, the insurance company may offer to settle your claim with a lump sum payment.

Attorney James Riley Hodder says settling can make sense if "you feel ready to go back to work," but if your condition could get worse, "settling your claim... ...may be a bad idea." Settling the claim means the weekly checks will stop, so it's important to make sure the settlement is reasonable for you to live off until you return to work.

If your insurance claim is denied, you can appeal to your state's workers' compensation board. A lawyer can help you make your appeal.

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