No one wants to get hurt or sick on the job, but it happens. 2.9 million workers suffered job-related injuries or illnesses in 2015. Florida alone saw over 52,000 workers comp claims in 2016.
Job-related injuries and illnesses can be one-time flukes.
A co-worker drives a forklift into a pile of boxes and knocks them onto you. You fall ill because someone spilled some chemicals and didn’t clean it up correctly.
Other times, the injuries or illnesses result from the nature of the work. Years of data entry gives you carpal tunnel syndrome.
Whether a fluke or the nature of the job causes them, these injuries and illnesses qualify you for workers compensation. Navigating workers compensation isn’t always easy.
Ever wish for a Workers Compensation layout that explained the major pieces? Wish granted
We’ve put together a layout to help you understand what workers compensation is and how the process works.
Let’s take a closer look.
We’ve broken up the layout into five sections to make it easier to read.
Workers comp is a specific kind of “no fault” insurance that most states require employers to carry. “No fault” coverage does not assign blame to anyone involved in the claim.
The insurance covers workers that get injured or ill as a result of working. Workers may receive medical care coverage, retraining and job placement services, and partial wage replacement.
Different claims entitle workers to different benefits. Workers may receive medical care coverage, retraining and job placement services, and partial wage replacement.
Workers compensation serves two main purposes. It tries to make sure workers get necessary treatments and return to work, if possible. It protects employers from personal injury lawsuits and excessive awards
As a general rule, workers compensation covers any injury or illness you get while doing your job.
Say, for example, that you’re working on invoices at your desk and someone spills very hot coffee on you. Workers compensation covers the burn because you were at work, doing your job and got injured.
Some things may not be covered, even if they do happen while you’re physically on the property. The following might be reasons for denying the claim:
Injury claims are generally easier to prove and get approved than illness claims.
Other people often see the injury happen and can confirm it to your employer. Injuries are also usually immediate and obvious. If your arm was fine when you arrived this morning but is broken now, it’s hard to claim it didn’t happen at work.
Illnesses don’t have witnesses. No one can see you catch the flu. So, even if everyone at work gets the flu, it’ll be tough to prove you caught it there.
Common repetitive movement conditions may be caused by activities outside of work. You may find you have to work harder to get compensation for these kinds of conditions.
The workers compensation process starts when you tell your employer about your injury or illness. You should report injuries as soon as they happen. Insurance companies may deny injury claims reported after 30 days.
Report illnesses as soon as you realize they are work-related.
When you report the injury or illness, your employer should fill out the First Report of Injury or Illness form and have you sign it. Your employer gets 7 days to report the injury to the insurance company. The insurance company will contact you right away with general information.
Don’t put off getting treatment until the claim is resolved. The insurance company must pay those medical bills if your claim is approved.
Getting examined and treated also creates medical records that you can use as evidence later, if necessary.
The insurance company will investigate the claim. This typically involves you seeing a doctor the insurance company picks. The doctor files a report on your condition with the insurance company.
The insurance company then uses the doctor’s report to help decide if your claim is real and how much compensation you should get.
Once they approve the claim, you should start getting a check every two weeks at 66 2/3% of your normal wage. The insurance company should also pay any outstanding medical bills and give you information about approved treatments and doctors.
Some workers compensation claims get denied. Sometimes the denials are legitimate. Other are questionable.
When you get denied, don’t think that kills your chance to get benefits. The government requires insurance companies to provide a reason for denying workers comp claims. You can appeal the decision.
If you believe your claim is legitimate, you can file a Petition for Benefits. The PFB, essentially, lists the details of the injury and the compensation you seek.
You or your lawyer file the petition with the Office of the Judges of Compensation Claims. You and the insurance company must try to reach an agreement about the claim before the judge will consider the claim.
If negotiation or mediation doesn’t work, the claim goes to trial and the court decides what, if any, compensation you get.
You can always consult with a workers compensation lawyer about your claim. Some circumstances make it more necessary than others.
Circumstances to consider bringing in a lawyer include:
It’s important to know that your employer can’t fire or threaten to fire you for filing the claim. They are not required to keep your job for you while you receive treatment or benefits.
With any luck, you won’t ever need to file a workers compensation claim. Should a co-worker knock boxes onto you with a forklift, we hope this layout helps you understand what happens with your claim.
If your employer or the insurance company drag out your claim, or you just need some guidance with the process, you don’t have to go it alone. You can always check out this layout again. If that’s not enough, we have extensive experience helping workers just like you. Please contact us today.