A Complete Guide
This guide will show you how to get through a worker’s compensation claim.
- Claims process
- Getting through a denial
- Finding a Lawyer
- and more
If you want to stop wondering what you should do and start working on your claim, then this guide is for you.
In this chapter, we’ll examine who is qualified for workers’ compensation.
We’ll talk about what injuries can qualify you to receive benefits, what could happen if you were partially responsible, and when workers comp and social security disability align.
Let’s Get Started.
Understanding If You're Qualified For Workers Comp
Were you injured at work? Yes
Then let’s take a look at what kind of injury you have and what type of worker you are. Many states go through private insurance companies and might not cover every type of employee
Not injured at work but on the job at another location? Then you might want to check out Chapter 4.
Qualifications for Workers Comp
First, you have to determine if you match the big 4 of workers comp or EBID.
E: Be an Employee
B: The Business has Workers Comp Insurance
I: You Were Injured at Work
D: Meet the Deadline to Report
The single most important is being able to prove you were injured on the job and not offsite and that it was done with no fault of your own.
It can be harder proving a case in a state that has private insurance vs. one that has state-provided insurance coverage.
Keeping evidence and documentation will be the best thing in the long run for your case. We will talk more about building a strong case in Chapter 3.
Not every state requires a job to cover workers comp. Some states start the count at 1 employee. Some begin at 5, and Texas makes it optional to not have coverage at all.
Before you begin a claim make sure that your work has the option.
Almost every injury or illness could qualify you for workers comp as long as it involved your job.
Ted works at a cafeteria. One day he skids on a puddle of coffee and lands hard on his back causing back pain and a sprain in his ankle. Ted has a workers comp claim.
Jay has been working on his uncle’s soybean field for 15 years. Jay gets diagnosed with Non-Hodgkin Lymphoma. This type of cancer might have originated from his uncle’s use of the weed killer, Roundup, on his fields. Jay has a workers comp claim.
Carla drives trucks for an ice company. One day, while at a gas station on delivery, Carla gets injured when she trips in the store. Carla has a workers comp claim and a chance at subrogation.
As long as you are able to prove that your injury occurred during work hours or because of the work involved you have a good shot at making a claim.
Sometimes even with a good case, you could still be denied or not fully covered.
If you caused the injury or were partially responsible for your injury you could have a harder time getting workers compensation or may get less for your injuries.
Worker's Comp and Social Security
Sometimes your injury is more severe than what workers comp can handle on its own.
Because worker’s compensation is only meant to cover your wages for a set period of time you may need to take short or long-term disability with your company or apply for social security disability with the state.
WORKERS COMPENSATION BASICS
In this chapter, we’re going to dig into what workers’ compensation is and how it works.
If you already have a good understanding and need more resources about starting, I recommend moving on to Chapter 3.
How Does it Work?
When you are injured on the job you are entitled to compensation for your medical cost and wages while you are away. Many companies carry insurance that you would use for this purpose.
After your injury you contact your employer, seek medical help, and when your claim is approved you are compensated for the medical care you received and the time you took off. If the settlement amount isn’t enough you can still take it to court.
The History of Workers Compensation
Before the 1900’s injured workers had no form of recourse at work. If you were injured the company did not help you and you were on your own for medical cost.
Unless you went to court. This is still an option today but it was far more expensive then.
Workers had all the burden of proof and many workers could not afford to pursue a case.
Labor unions started us on the path toward workers comp. They demanded that employees be compensated for their injuries and given time to recover.
Now workers comp Pays for far more than just missed wages.
Workers Comp Can Help You More Than You Know
Did you know that workers’ compensation is more than just covering lost wages and medical bills?
Workers comp could cover a variety of things that could help get you back to work.
What Workers Comp Covers:
- Lost Wages
- Medical Treatments
- Survivor Benefits
- Vocational Rehabilitation
Most people know that workers comp will cover your medical bills or lost wages but not many people know what else is covered.
Mileage reimbursement helps you pay to get to your medical appointments. Disability and disfigurement can pay for extreme injury where you are likely to not be able to work again. If you were to die, your family would receive survivor benefits.
Vocational rehabilitation is another great benefit of workers’ compensation. When your injury is preventing you from working, workers comp can step in a provide rehabilitation to help you get back to work.
BUILDING A STRONG CASE
When you make your worker’s compensation claim, having documentation about your injury could help your case.
If your claim is denied, or you feel that the compensation is enough for your case. Going to court will require you to have a strong case prepared.
In this chapter we’ll talk about how to build your case and what you’ll need to do.
Document Your Injury
You’ve heard the term, “documentation”, in a lot of our guides and a lot of the other guides online. This can be hard to do after an injury. When you’re focused on the now it can be hard to think about what you might need in the future.
So, when you hear documentation, we like to think of this as a checklist you should have in your mind when the accident happens. Just like when you get in an auto accident.
You have that mental checklist of, “Remember to get their information. Give them our information. Take pictures of the scene. Call insurance.”. You should also have a checklist when you’re at work.
When something happens, think of your checklist.
- Contact your employer that you were injured (having this in email or text could give you physical proof)
- If you can get a picture of the injury and the cause
- Go to the doctor immediately after (this gives you medical documentation)
- Contact your employer with what happened and your need for a worker’s compensation claim.
Medical treatment is the most important item on your checklist. You can’t prove an injury without having medical information to back you up.
Even in smaller injuries, it’s still good to see a doctor. You may think you just sprained your uncle, but it could have been broken. Not only will this help you heal better but could help you take the time you need to recover.
Talk to Your Employer
Communicating with your employer is also pretty important.
Not only will this help your job stay in the loop but can help you to prove that your injury happened during regular work and can kick start your workers compensation claim.
Talk to Your Lawyer
Not every worker’s comp claim is approved or covers as much as you would like though.
Sometimes speaking to a lawyer and going to court is your best bet at getting the compensation you deserve after an injury.
Forming a solid case is extremely important should you decide to take your case to court.
3RD PARTY CLAIMS OR SUBROGATION
Not everyone’s job has them held up in an office at the same location every day.
Some workers have to travel to different locations or job sites. When you get hurt somewhere other than your company’s main location you have something else to think about.
It sounds scary but it’s actually good for your case and better yet for your employer’s insurance company.
What is Subrogation?
The easiest explanation is that subrogation is when you pursue legal action against a third party. So, let’s say that you’re injured while on location. If the inaction of the third party (the person who owns that property) caused your injury, then they will also be providing your lost wages/medical costs/etc. For the most part, the insurance agency, or in some cases state agency, will take care of this for you.
When you’re pursuing a lawsuit, your lawyer will handle this for you. If the injury was particularly severe then it’s best that a lawyer is handling the situation.
Just like any time you’re dealing with insurance, if it’s minor the settlement should be fine but when it’s major find representation.
HOW MUCH YOU SHOULD EXPECT
A lot of people we talk to wonder if workers’ compensation is really worth it.
If you’re injured at work. Go for it. Workers comp does not look favorably on last-minute cases. When you’ve been injured, start the process as soon as possible. Once you’ve gone past your deadline there’s no way to file.
So what can you expect?
What Workers Comp Covers
Workers’ compensation primarily covers lost wages and medical bills. But can also potentially cover things like disability, medical treatments, mileage reimbursement, survivor benefits, and vocational rehabilitation. The type of coverage you get is based on not just your state but the extent of your injury. What we can say for sure though is:
- Pays for 2/3 of your lost wages
- Your employer’s insurance company should respond to your request in about 2 to 3 weeks after you file. If you’re approved you should receive your first check-in 14 days. You should get each new payment about 2 weeks from the last.
- You can receive this benefit for up to 52 weeks
When to File & When to Go to Court
In most cases, you should be fine taking the settlement offered to you by workers’ compensation.
If your injury was very serious and you were left disabled, disfigured, or terminally ill, then you should seek legal action instead of just a claim. Should your employer prevent you from filing a workers compensation claim then you should seek legal action.
If your claim has been denied and you know you have a case then you should seek legal action.
If you are worried that you might not have a claim after a denial, most lawyers offer free consultations where they will inform you of your odds.
THE WORKERS COMPENSATION PROCESS
The process of filing workers’ compensation could not be easier.
As long as you have been keeping documentation of your case.
The number 1 reason that cases are denied and injured works have to resort to a court case is lack of documentation.
Let’s go through both processes together!
How to Have an Easier Case
The biggest thing you have to prove is that your injury occurred at work or was caused by work.
Not all injuries are so easily proved, however. Illnesses like Non-Hodgkin’s Lymphoma might require you to go to court with the help of a lawyer to prove your case. Sometimes, if the illness is well known to be a part of the job you can have an easier time.
Having documentation can also fast-track your case. If you have proof of your injury occurring at work, medical records, and began your claim soon after the injury you are more likely to get your claim approved.
Why Cases Are Not Always Simple
Not having that documentation can really mess up a case. If you can’t prove that it happened at work or that there was an injury at all then you risk your employer’s insurer throwing out your case.
Sometimes you can get caught up in the moment and forget to take pictures or maybe you didn’t think it was so bad at first and didn’t go to the hospital. It’s in these situations that you might be looking at going to court.
A lawyer will help you to build a case around the evidence and witnesses that you do have and convince a court on your behalf. You may need to turn over medical records to your lawyer or have them investigate on your behalf.
IS YOUR SETTLEMENT FAIR FOR YOUR CASE?
Is my settlement enough? You may be asking.
If you have a relatively minor injury but will still need time to recover or regain your previous strength you might be alright taking that settlement.
But how do you know for sure?
Should I Settle?
So when should settle your case and when should you hold out? If you have a temporary injury you should expect to have your medical bills covered and maybe even the gas you used to drive to the hospital. You should also expect 2/3 of your salary while you are away.
If that doesn’t happen you don’t have to settle. You can take them to court to attempt to get what you were owed from the injury. If your claim is denied you might also seek to settle your case in court if you believe that you have one.
It’s a permanent injury where it gets a bit complicated.
Depending on your state and the nature of the injury you should be expecting quite a bit more. Especially since many permanent injuries lead to never working again. Consulting with a lawyer in these rare cases can be extremely important.
What If My Injury is Permanent?
Before you look into permanent total disability benefits make sure that you have had a doctor determine that it is indeed permanent and what your limitations in the working environment will be.
With this form of documentation, you will have a much easier time proving your case to your insurer but we recommend talking to a lawyer before. Knowing the exact amount that your injury is worth is very important in this type of situation. If your settlement does not cover the cost of your injury then pursuing a lawsuit is your only option.
WHAT TO DO WHEN YOU NEED A LAWYER
So you’re pretty sure you’re going to need a lawyer. Sometimes there isn’t a way around that.
Maybe your claim was denied or this is a very serious injury and you need to get the maximum settlement.
Either way, you need to know how to make the best decisions when it comes to finding a lawyer.
My Workers Comp Claim Was Denied
Your worker’s compensation claim was denied. This could be for several reasons.
You didn’t have enough documentation of your injury.
It was believed your injury did not happen at work or the amount of time to recover amounted to a sick leave.
In these cases talking to a lawyer is your best option. Using a free consultation you can discover your odds of winning in a court of law and decide if you wish to pursue the case further.
Not having enough documentation could be solved with a skilled lawyer if you still wish to pursue action in the courts. Combining what evidence you do have, with any eyewitnesses you can provide, and a convincing argument from a lawyer may be all you need. The less documentation you have though, the slimmer the odds. Many lawyers may not take you on if they feel that your case may fail.
If you have evidence that your injury did happen at work or that the injury caused you a significant amount of harm and they still have rejected your case, you may have better odds of winning in court. Sometimes just the threat of taking them to court could solve your issue.
My Employer is Making This Difficult
By law, your employer can not prevent you from accessing workers’ compensation insurance if the company has it. If your employer is preventing you from receiving assistance then you may have more than one type of case to settle in court.
Make sure that you have let your employer know your intention to file a workers comp claim to the best of your ability. You also have the ability in states like Ohio to file with the BWC online if you need to. But if your boss is threatening you or making your work life harder then you may need to get a lawyer involved.
This is Life Threatening or Permanent
If your situation is very severe, life threatening/permanent, then getting a lawyer involved is your next step. In very few cases will you be able to receive the full amount that you deserve for such a large scale injury.
You can still make your workers comp claim if you would like to however. If the amount they offer seems reasonable to you, you can still take the settlement. However, pursuing it in court could lead to a much larger settlement