The Delaware workers’ compensation system covers medical treatment and pays benefits to employees who are injured at work. In most cases, workers’ comp is an employee’s only method of getting compensation from his or her employer. (To learn about the exceptions, see Workplace Injury: When You Can Sue Outside of Workers’ Compensation.) Below we explain the workers’ comp system in Delaware and how to start a claim if you have been injured at work.
Nearly all private employers in Delaware are required to have workers’ compensation coverage for their employees. Employers often secure coverage through private insurance companies. The insurance company reviews claims and decides whether to accept or deny them. (Larger employers can receive certification from the state to be self-insured, which means that they reviews claims and pay their employees directly.)
Workers’ comp is a no-fault system, meaning that employees can usually collect compensation regardless of who was at fault for the injury. However, certain injuries—such as those caused by the employee’s intoxication or participation in horseplay—are not covered. (For more information, see Workers’ Compensation: Is Your Injury or Illness Work-Related?)
The first step to making a workers’ comp claim is to report your injury to your employer. You must give your employer notice of your injury within 90 days, or you might lose your right to collect benefits. However, it’s best to give your employer notice right away. The longer you wait to report your injury, the more skeptical the insurance company might be of your claim. Also, the sooner you give notice, the sooner you can begin to receive benefits.
Once you give notice of your injury, your employer should notify its insurance company and file a First Report of Occupational Injury or Disease form with the Delaware Office of Workers’ Compensation. The insurance company will then investigate your claim, usually by talking to you, your employer, and your doctors. If your claim is accepted, you will begin to receive medical coverage and wage loss benefits.
In Delaware, the injured worker gets to select the treating doctor. Workers’ compensation should pay for all necessary medical treatment related to your work injury. This includes the cost of doctors’ visits, hospital stays, prescriptions, and medical equipment. You can also receive disability benefits if you need time off work while you are being treated or if you have a permanent impairment.
If the insurance company denies your claim, you can challenge its decision with the Delaware Office of Workers’ Compensation. (For common grounds for a denial, see Denied Workers’ Compensation Claims.) To do so, you must file a petition for a workers’ comp hearing before the Industrial Accident Board within two years of your injury.
Many workers can handle the initial workers’ comp claim process on their own. However, if the insurance company has denied your benefits or is disputing the amount that you are owed, you may want to consider hiring a lawyer. This is especially true if you need to attend a workers’ comp hearing, which follow complex procedural rules. For more information, see Should I Hire a Workers’ Comp Attorney or Can I Handle My Own Case?