If you've suffered a work-related injury or illness, you may be entitled to workers' comp benefits, including medical care, part of your lost wages while you're off work during your recovery, and permanent disability benefits if the injury left you with long-lasting limitations.
To get these benefits, you must report your injury and file a claim according to your state's procedures. While each state has its own workers' comp system, the procedures for filing a claim are generally similar. Below we'll discuss the workers' comp claims procedures that all states share.
In nearly all states, the first step to getting workers' compensation benefits is to report your injury or occupational illness 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 attention if your injury requires it. For emergency treatment, you can go to the nearest emergency room or urgent care. For all other treatment, you will need to follow your state's rules for seeking medical treatment.
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.
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 and details on the filing procedures for workers' comp claims in certain states.)
You can get information, forms, and assistance from your state's workers' compensation agency. In the unlikely event that your employer refuses to cooperate with you in filing a claim, a call to your local workers' comp office will usually remedy the situation.
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 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.
If your claim has been denied, 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 your case in many ways, from gathering evidence that bolsters your claim to negotiating with the insurance company or representing you in hearings.
And a lawyer usually won't cost you anything up front. In almost all states, workers' comp attorneys charge a percentage of your benefits if you win—and nothing if you lose.