If you've suffered a work-related injury or illness, you might be eligible for workers' compensation benefits that cover your medical care and a portion of your lost wages.
Here's what you need to know about how long the workers' comp process takes.
When Will I Get a Decision on My Workers' Comp Claim?
How long your workers' comp claim will take depends on where you live. State law determines the rules for workers’ compensation, and the deadlines for responding to claims by injured employees are different in each state.
In most states, however, your employer’s insurance company should respond within about two to three weeks after you’ve given notice of the injury or filed a claim.
In Texas, for instance, the insurer must either deny the claim or begin to pay benefits within 15 days after it received written notice. The deadline in Pennsylvania is 21 days after notice of the injury.
How Long Does a Workers' Comp Investigation Take?
If the workers' comp insurer wants to conduct an investigation into your claim—if, for example, it has doubts that your injury was truly work-related—it can conduct an investigation before issuing its decision.
A workers' comp investigation can consist of witness interviews, a review of medical records and accident reports, and even video surveillance and social media tracking.
States impose strict deadlines for how long such investigations can take. In most states the deadline is between 14 and 30 days, although states sometimes allow extra time (discussed below).
Missed Deadline for Deciding Workers' Comp Claims: What Happens?
If you don’t receive an answer within the deadline, some states will consider your claim to be accepted. For example, California requires the insurance company to reject a workers’ comp claim within 90 days after the employer first learned about the injury; otherwise, it’s presumed that the claim is approved.
However, the insurer can overcome that presumption and deny the claim if it discovers new evidence after the end of the 90-day period.
"Pay and Investigate" Workers' Comp Claim
Many states allow insurers extra time to investigate the claim if they pay benefits in the meantime. In Florida, for instance, the insurance company must either respond to a petition for benefits within 14 days after receiving a petition for benefits, or pay benefits while it investigates.
If it chooses the “pay-and-investigate” option, the petition will be considered accepted if the insurer doesn’t give a final answer within 120 days after it starts paying benefits, unless there’s new evidence.
Further Information
You can find information about your state’s rules for responding to claims by checking with the state workers’ compensation agency. And if the insurance company does reject your claim, learn how to appeal a workers’ comp denial.
Finally, if you need help with filing a claim or negotiating a settlement, contact an experienced workers' comp attorney to discuss your legal options.