When you have a work-related injury or illness, workers' compensation will pay for your medical care and part of your lost wages while you’re off work. It will also pay permanent disability benefits if you don’t fully recover from your injury or illness and for vocational rehabilitation if you need to train for a new line of work. To get these benefits, you must report your injury and file a claim according to your state's procedures.
In nearly all states, the first step to getting workers’ compensation benefits is to report your injury to your employer. States have very different time limits for notifying an employer of a work injury or illness. The deadline is often 30 days or so, but it can be as short as a few days and as long as a year.
Regardless of how much time you have, you should inform your employer of your injury as soon as possible. The longer you wait, the more skeptical your employer or its insurance company will be of your claim. And, the sooner you file your claim, the sooner you can receive benefits.
You should also get immediate medical care if your injury requires it. For emergency treatment, you should go to the nearest emergency room or urgent care. For all other treatment, you will need to follow your state’s rules for getting treatment. Several states require you to go to a treating doctor or medical provider network that your employer has designated. If you treat with an unauthorized provider, workers’ comp may refuse to pay your medical bills. (To learn more, see our article on who selects the treating doctor in a workers’ comp case.)
Once you report your injury, your employer should give you any necessary forms to fill out. Typically, the employer will submit these forms to its insurance company and the state workers’ compensation agency. In some states, this will be the official start to your workers’ compensation claim. In these states, you will need to file official paperwork with the state workers’ comp agency only if your benefits are denied and you want to appeal the decision.
However, in other states, you will also need to file an official workers’ comp claim form with the state workers’ compensation agency at the start of your case. The deadline for this step also varies from state to state. While workers often have a year to file the claim, the timeline could be significantly shorter in some states. (Learn more about the various time limits in workers' comp cases.)
In the unlikely event that your employer refuses to cooperate with you in filing a claim, a call to your local workers’ compensation office will usually remedy the situation. (You can find phone numbers for workers’ compensation officials in each state by using this map tool on the U.S. Department of Labor’s website.)
To learn more details about the procedures, requirements, and deadlines for filing a workers’ compensation claim in your state, see the our state-specific articles on filing a workers' comp claim. (Federal employees are subject to a completely different workers’ compensation system. You can find forms and instructions for filing claims at the website of the Division of Federal Employees' Compensation.)
The insurance company will conduct an investigation before approving or denying your claim. The insurer must tell you what it decided, usually within about two to four weeks. In some states, if your claim isn't denied by the deadline, it will automatically be considered approved.
If the claim is approved, you’ll start receiving benefits. If your claim is denied—which often happens—you have the right to appeal. This is the point when you should speak with a lawyer as soon as possible. There are many reasons for denials—from missed deadlines to disputes over whether your medical condition is related to work. The appeals process is complicated, with strict deadlines. An experienced workers’ comp attorney can help you decide whether it’s a good idea to pursue an appeal and, if so, can protect your interests throughout the process. Also, a lawyer often won’t cost you anything up front. Generally, workers’ comp attorneys charge a percentage of your benefits if you win—and nothing if you lose. (To learn more, see our state-specific articles on how much workers’ comp lawyers charge.)