If you were injured at work in Vermont, the workers’ compensation system will cover your medical treatment and pay benefits if you need time off work. In most cases, workers’ comp is your only option for getting compensation from your employer. (However, there are a few exceptions. To learn more, see Workplace Injury: When You Can Sue Outside of Workers’ Compensation.) Below we explain the workers’ comp process in Vermont and how to start a claim if you have been injured at work.
All private employers in Vermont are required to have workers’ compensation coverage for their employees. Most employers are insured by private insurance companies. The insurance company is responsible for reviewing and paying out accepted claims. (Larger employers can also get the state’s approval to be self-insured, which means that they reviews claims and pay their employees directly.)
Workers’ compensation covers injuries that happen while you are carrying out your work duties. For example, if you are injured while operating machinery at work, you will likely be covered. Similarly, if you fall and hurt yourself while running a work errand, you will likely be covered. On the other hand, workers’ comp will generally not cover injuries that happen during your commute to and from work or that happen off-site during non-working hours.
Workers’ comp is a no-fault system, which means 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 participation in horseplay or practical jokes—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 right away. If you delay in giving notice, you might lose your right to collect benefits. Once your employer is aware of your injury, it should notify its insurance company of your claim. If your employer fails to do so, you must file an Employee’s Notice of Injury and Claim for Compensation (Form 5) with the Vermont Workers’ Compensation Division within six months of your injury.
The insurance company will investigate your claim, usually by talking to you, your employer, and your doctors. The insurance company has 21 days to accept or deny your claim. If your claim is accepted, you will begin to receive medical coverage and wage loss benefits almost immediately.
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. In Vermont, your employer and its insurance company get to select your doctor for your initial treatment. After that, you may switch to your own doctor by filing paperwork with the Workers’ Compensation Division.
If the insurance company denies your claim, you can challenge its decision by filing a Notice and Application for Hearing with the Workers’ Compensation Division. The Division will hold an informal conference with you and the insurance company to try to help you settle the dispute. If you cannot agree on a settlement, you will have a formal hearing before a workers’ compensation judge. (For common grounds for a denial, see Denied Workers’ Compensation Claims.)
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?