Thousands of work-related injuries occur each year, and workers receive compensation through the workers’ compensation claim process. Some of the most common injuries in the workplace are back injuries, burns and cuts.
Occupational diseases and emotional injuries are lesson common occurrences, but they still happen. If you receive an injury while you are at work, you may be entitled to the benefit.
All employers that have a significant amount of employees have to keep a certain amount of coverage for their workers. The following is some information on how compensation works for injured employees.
Workers’ Compensation in a Nutshell
In brief, workers’ compensation is partial paycheck coverage for workers who get hurt conducting a work-related activity. Workers’ comp is there to help when employee injured while working. The benefit is available for employees as long a they are legitimate employees, and the business falls under the bracket of businesses that have to carry the insurance.
The benefit pays a certain percentage of a person’s paycheck until that person is able to return to work and resume his or her original duties. Workers’ compensation covers the medical expenses that the worker accrues during the recovery period.
Who Is Eligible for Workers’ Compensation?
Any person who qualifies as an employee and has a legitimate work injury is eligible for workers’ compensation. The benefit does not cover independent contractors and other self-employed individuals.
A work injury is defined as something that occurs in the midst of one’s work duties. Some people qualify for benefits even when they get hurt at a site other than the job location.
However, not all such employees are eligible. A pizza delivery person can receive workers’ compensation for an injury that occurs during delivery, but a factory worker would not qualify for the benefit for an incident that occurred on the way to work.
How to Claim Benefits
Each state has its way of explaining how to claim injury compensation. A general rule, however, is to report the injury to the employer as soon as possible. The injured worker should not hesitate for one second on telling the employer that he or she has received an injury. Sometimes the employer is the one who files the paperwork and initiates the workers’ compensation claim for the employee.
Other times, the employee must do it himself or herself. Either way, the injured party only has a certain amount of time to report the injury. Failing to report the injury in a timely fashion could adversely affect the claim approval.
Usually, the worker must report the injury to the employer within 30 to 60 days. The full statute of limitations for workers’ compensation cases may extend to up to one year, however.
Visiting Medical Experts and Listening to Advice
The first thing that an injured employee must do after notifying the supervisor of the injury is visit a medical specialists. Employers have the right to dictate the medical specialists in some states but not in others. That means that the injured employee must receive an examination by the physician of the employer’s choice. That physician will then determine:
- Whether the worker has a legitimate injury
- Whether the worker can perform any duties at all
- When the worker can return to work
The physician will provide the worker or employer with specific information such as a diagnosis and a recommendation for treatment. The worker must adhere to a restricted work schedule if the specialist recommends it.
The worker must also return to work when the physician says that he or she must return. In some cases, the employee does not feel as though the physician’s diagnosis or recommendation is correct. That person is welcome to speak to an attorney in such a situation.
The approval board or insurance company decides whether the employee’s claim for benefits receives an approval. If the claim is approved, the employee receives a check shortly after that.
If the claim is not approved, the claimant can either return to work or appeal the decision. The person should file the appeal as quickly as possible.
Reasons for Denial
Many reasons exist as to why a workers’ compensation claim may receive a denial. One of the most common reasons that such claims get denied is the the employee fails to obtain the appropriate medical treatment. Other reasons for denials include:
- Insufficient paperwork
- Intoxication or horseplay caused the incident
- Unapproved medical treatment or provider
- Late injury notice
- Injury is not work related
The injured person must ensure that the injury is legitimate, relates to work and is through not fault of his or her own for the most part. Workers’ compensation is generally a “no fault” benefit.
However, intoxication and horseplay can severely hinder a benefit approval. Injured workers should always contact an attorney if something is unclear about the case. Attorneys are always willing to help people gain knowledge and understanding of workers’ comp laws.