Have you or a loved one been injured at work? If so, you may be wondering what the workers’ comp process is like and how you can file a claim. If you are injured on the job and you qualify for workers’ compensation, you deserve to be compensated for your medical expenses and lost wages.
Workers’ compensation is state-mandated accident insurance paid for by employers in the event that an employee is injured or gets sick due to working conditions. Employees are not required to contribute to workers’ compensation from their own salaries. Whether you qualify for workers’ comp benefits depends on the state where you reside. If you live in Missouri, for example, you may be eligible for workers’ comp if your employer has five or more employees.
With a workers’ compensation attorney from The Law Office of William L. Phalen on your side, you may be able to recover the compensation you deserve.
Know What to Expect After Filing a Workers’ Compensation Claim
What happens immediately after filing a workers’ comp claim? After you file your claim, your employer should receive it, complete the required fields on the form and sign it. Once both you and your employer have filled out the form, the claim should be submitted to a claims administrator. This person is assigned to handle all workers’ comp cases on your employer’s behalf or is employed by the insurance company.
A copy of your completed claim should be handed to or sent in an email to the claims administrator, or claims adjuster, within one workday after you file the claim. Be sure to also keep a copy for yourself.
After your claims administrator receives a copy of your workers’ comp claim, they will either accept or reject it.
What Happens If My Claim Is Accepted or Rejected?
Your next steps depend on whether your workers’ compensation claim has been accepted or rejected. Here’s what may happen in either scenario:
- Accepted claim: If your workers’ comp claim is accepted by the claims administrator, your injury or illness and the associated expenses may be covered by workers’ comp, including your lost wages, medical bills and loss of earning capacity. Immediately after your workers’ comp claim is accepted, you may begin receiving paid medical care.
- Rejected claim: If your workers’ comp claim is rejected by the claims administrator, this means they believe your injury or illness does not meet the required criteria for eligibility for workers’ comp. After your claim is rejected, you can legally challenge the decision by seeking legal assistance from a qualified workers’ comp attorney. There may be strict deadlines in place, so take action as soon as possible.
However, what if your claims adjuster does not respond to your claim at all? A lack of response from a claims adjuster is not necessarily a bad thing. If you have not heard back within a certain amount of time set by your state, and you have not been sent a letter about your claim being rejected, then your claim may be considered accepted automatically.
When Can I Return to Work?
If you believe you can return to work after being injured at the job, you should consult with your primary physician about whether this would be safe while you are still recovering. If you have not yet fully recovered or completed your treatment, then your physician, employer and attorney will decide the type of work you can perform during your recovery.
Remain Calm During the Workers’ Comp Process
While it may be challenging, the best way to handle these claims is by remaining calm. After suffering an injury or becoming ill, you may experience an elevated stress level. Your injury may be causing you pain, and feeling stressed and overwhelmed is understandable.
The best thing any parties involved in a workers’ comp case can do is to stay calm. Do your best to relax and keep in mind that, though it can be a stressful process to endure, your health is always a top priority. We recommend seeking proper medical care to alleviate any pain and anguish.
If you have been injured, you may want to seek care for your injury immediately. Receiving medical care is the first step to getting control of the situation, which can help you decrease your stress levels.
Get Documents Organized
To ensure a smoother workers’ comp process, it is important to gather and document the facts. Utilize the following tips for organizing your documents and setting up your workers’ comp claim:
1. Start the Process in a Timely Manner
Report your work-related injury or illness in a timely manner. Many workers may feel a minor pain like they have pulled or strained a muscle, but they dismiss it and believe they will feel better the next day. Though this can be true, you may still want to report the injury to your supervisor. Let them know you hurt your back while you were lifting something heavy, for example.
In Kansas, for instance, you have 20 days after seeking treatment for the injury to report it to your employer if you still work for that employer and only 10 days to report the accident if you no longer work there.. In Missouri, on the other hand, you have 30 days to notify your employer of the injury.If you cannot find a supervisor to report the injury or illness to, then at least mention it to one of your co-workers.
2. Specify the Cause Upfront
Be upfront about the cause of your injury or the time your pain began. If you are aware of what caused your injury, be as specific as possible about the cause. It is important for your case that you can prove you were injured while performing a work-related activity or that your work activity was a substantial factor that contributed to your pain.
However, if you are unsure of what exactly caused your pain, this is okay. No matter what led to your injury, you may want to err on the side of caution and report the injury as soon as you notice it. If you work in a bakery, for example, and you experience pain while squeezing frosting tubes, report this pain to your supervisor, even if you are not sure what exact incident caused it.
3. Seek Medical Attention as Soon as Possible
Another tip to follow is seeking medical attention as soon as possible. This may simply mean being examined at an urgent care clinic or by your primary physician. Seeking medical attention is important for your injury, and it is also crucial for gathering the proper documentation for your workers’ comp claim.
When you are seen by a doctor or nurse, they will ask you what happened. Tell the story of what occurred, be honest and provide all the details you remember. As long as your pain can be tied directly to a work activity, this may be sufficient for backing your report after the claims adjuster receives your medical records. Following a workers’ comp claim, the claims adjuster will receive the medical records of your initial medical treatment.
4. Keep the Details Consistent
Telling the truth is essential, and when you are honest in reporting the injury, you will ensure your story’s details remain consistent. We recommend being consistent in your details with every person you speak to about your injury, including your supervisor, co-workers, physician and attorney. If you are inconsistent in your reports of the injury, this could lead to your employer’s insurer denying your claim and may make your claim more difficult for your attorney to defend.
Report your work-related injury or illness in a timely manner and be as specific as possible with the details. If you follow these tips, you may be able to ensure your claim is properly documented.
Work With Your Employer, If Possible
If you have been injured at work, you may be wondering about working while disabled. Many companies have a return to work program that may address this concern.
What Is a Return to Work Program?
A return to work program is a plan for injured employees returning to the workplace once they are medically able to work again. The goal of a return to work program is to enable an injured worker to continue being productive during their recovery and maintain a connection with their workplace. Through a return to work program, several advantages are offered to both you and your employer.
Advantages of a Return to Work Program for Employers
The following are the advantages employers enjoy from a return to work program:
- Retaining experienced employees: Injured employees who stay at home for a lengthy period may become discouraged, feel disconnected from the company and decide to leave. With a return to work program, an employer can keep those valuable, experienced employees.
- Improving employee relations: When employers create successful return to work programs, they send a message to their employees that they care about them and their welfare.
- Reducing turnover: When an employer can get injured workers back to work quickly, this can allow the company to avoid the cost of dedicating time and money to hiring and training a temporary or permanent replacement.
- Lowering workers’ comp costs: Injured workers who return to work on a part-time basis will collect less in disability benefits than a worker who does not return to work and remains at home.
- Increasing productivity: Even if an injured employee cannot perform at full capacity, they may be more productive at work than at home.
Advantages of a Return to Work Program for Employees
The following are the advantages employees enjoy from a return to work program:
- Financial stability: Typically, disability benefits are just a fraction of your average weekly wage. If you can return to work, you will likely earn more money than you would from disability benefits.
- Better morale: You may also feel more secure about your job if you know your employer will facilitate your return after your injury or illness.
- Skill retention: A return to work program may help you retain your valuable skills, as you will be continuously using these skills through your work.
- Social connections: As an injured employee, if you return to your job promptly, you can better retain your social connections. You may also regain a sense of purpose due to your daily work routine.
Wait to Hear Back From Claims Administrators
What is the typical length of time it takes to hear back from claims administrators at an insurance company after filing a workers’ comp claim? How long it will take you to hear back from your claims administrator depends on the state where you live. Both the rules of workers’ comp and the deadlines for responding to workers’ comp claims are set by state law.
In most states, though, an employer’s insurance carrier responds in a few weeks after you have filed your workers’ comp claim. In Kansas, if you report your injury and are off work for at least seven days, you may be eligible for workers’ comp benefits. However, you will be paid for those first seven days off work only if you are off work for at least 21 days.
On the other hand, in Missouri, you may begin receiving wage loss benefits after being off work for three days. You will receive payment for these three days only if you are off work for 14 days.
Reach Out to a Lawyer
Finally, it is crucial to reach out to a lawyer to navigate the workers’ comp process in case of any trouble. Some things you may want to prioritize while searching for a law firm include finding one with extensive experience in handling workers’ comp claims and providing clients with personalized attention. You may want to contact a workers’ comp attorney if:
- Your claim has been rejected.
- Your checks are not arriving on time.
- You have concerns about your claim.
- You are not receiving the amount of benefits you deserve.
- Your employer says you are not covered by workers’ comp.
- Your employer or employer’s insurance carrier claims you have not suffered a work-related injury or illness and that you can return to work.
If you believe your claim may be problematic or you have already run into legal challenges to get your claim honored, working with a workers’ comp attorney is crucial.
Contact The Law Office of William L. Phalen
We fight for justice for injured workers at The Law Office of William L. Phalen. We know hardworking people can struggle to get the compensation they deserve from giant insurance companies and large corporations, and we realize these companies often have vast resources and high-profile legal teams on their side. With a firm like Phalen Law Firm on your side, you stand a fighting chance against these staggering odds.
Our small, passionate group is dedicated to taking on cases in which a person has been injured or killed at work. If you are searching for a law firm with experience in taking on America’s biggest insurance companies, or you want to work with a lawyer who cares about ordinary people, look no further than Phalen Law Firm. For a free, personalized consultation to secure the workers’ compensation benefits you deserve, contact us at Phalen Law Firm today.