What Is The Process Of A Workers’ Compensation Claim?

workers' compensation claim process

Workers are the backbone of America. Without them, almost every aspect of life would grind to a halt; supermarket shelves would be bare, no new buildings would get constructed, there would be no public transportation, and the list goes on. The essential nature of the workers of America means that they need to be taken care of as much as possible, and that includes taking care of them when they get injured on the job. That is the purpose of workers compensation. 

Workers compensation provides recompense for the losses suffered by a worker when they get injured while on the job. There is a process that the injured worker needs to go through before they can collect their compensation, but it will usually go through smoothly and without any problems. However, if there is a problem, then that worker might need to contact an attorney to get legal help. If you live in the Fresno area and need help with your workers compensation claim, then contact the lawyers Grossman

Step 1: Reporting The Injury To The Employer 

Needless to say, the injury suffered by the worker must have occurred while they were on the job. That means immediate injuries like a broken limb suffered from falling off a ladder, or delayed injuries like developing respiratory problems from breathing in toxic substances like asbestos. Injuries caused by horsing around or goofing off are generally not eligible for workers compensation. 

Once the worker has been injured, they need to seek medical attention as quickly as possible if it is an emergency. If it is not urgent, then they can visit a doctor to get treatment on their own time, but they should make sure to get a medical report to file with their claim if they do so. Once they have received treatment, they need to write a notice to their employer detailing the injury and the incident that led to it. 

The worker has a limited amount of time to present that notice to their employer and that varies from state to state. Some states require a notice in as little as thirty days while others allow up to a year or two. If the worker suffers a condition that does not immediately manifest, like cancer or a lung injury, then they need to notify their employer once they learn about that condition. 

Step 2: The Employer Provides The Employee With The Necessary Documents 

Once the employer has been notified of the injury, they must then provide the injured employee with the forms they need to file their workers compensation claim. Those forms should include reporting forms for the workers compensation insurance provider as well as the state’s workers compensation board. Information about the worker’s rights and benefits as well as information about returning to work should also be included. These forms can be provided after the worker has been injured or when they were hired, but they should be provided with those documents otherwise that could lead to legal problems for the employer. 

Step 3: The Worker Files The Claim 

Once the employee has completed the forms provided by their employer, they then submit them to the workers compensation insurance provider. The employee’s doctor or healthcare professional needs to send a medical report to the provider as well. In some cases, the employee needs to send documentation to their state’s workers compensation board as well. 

Step 4: The Insurance Provider Approves Or Denies the Claim 

After the claim has been filed, the insurer will either decide to accept it or deny it. If they accept it, then the worker can accept the payment offer and use it to take care of their medical bills and some of their lost wages. The insurer will deny the claim if they do not think that the worker qualifies for any benefits. Should that happen, the worker can appeal or ask the insurance company to review their decision. If the insurer denies the appeal, then the employee may need to seek legal representation to help them get the compensation to which they believe they are entitled. 

Step 5: The Employee Goes Back To Work 

Once the employee has recovered enough to return to work, they must send a written notice to their employer and their insurance company that they are ready to return to work. If the employee is unable to work or continues to experience effects from the injury, then the insurance company may continue to pay disability benefits. 

Employees And Employers Should Follow The Workers Compensation Process

It is important for employees to follow the workers compensation process if they want to get the benefits that they need. It is just as important for the employer to follow the process if they want to avoid a lawsuit. That way both parties can avoid any legal troubles and the employee can get the help they need when they get injured on the job and are unable to work. The only time that the worker should need a lawyer is if the insurance company rejects their claim. Hopefully that does not happen, but if it does, then the employee needs to hire a lawyer so that they can get the compensation that they need.

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