If you're injured on the job, or you develop an occupational illness or repetitive stress injury, you might be entitled to workers' comp benefits. These benefits include compensation for medical care and lost wages.
To ensure that you receive your benefits, you'll need to follow your state's rules for reporting your injury, filing a claim, and, if your claim is denied, appealing the insurance company's decision.
How Long Does the Workers' Comp Process Take?
If your claim is straightforward and uncontested, you can receive benefits in as little as a week or two after reporting your injury. But most cases take longer.
According to a survey conducted by Martindale-Nolo, the average time for workers' comp cases to be resolved was more than 15 months, with only 19 percent of respondents reporting that their claims took less than six months.
Delays That Can Affect Workers' Comp Timelines
What makes a case take longer than average? How long your case takes can be affected by a number of factors, including:
- missed medical appointments
- mistakes on your paperwork
- delays caused by your employer or its insurer
- lost paperwork or backlogs at the workers' comp agency, or
- long time reaching maximum medical improvement (the point at which your medical condition stabilizes)
What to Do If You're Injured at Work
Report the Injury to Your Employer
As soon as you can, tell your supervisor about the injury and ask for the form to make a written report. You could lose your right to workers' comp benefits if you don't make a report within your state's required time period.
Deadlines for reporting vary widely by state, but most states require you to report your injury or illness to your employer within 30 days or less of the date it occurred. In some states, the reporting period is as short as three or four days, so be sure to check with your state's workers' compensation agency to avoid missing the deadline.
Regardless of how long you have, it's a good idea to report your injury as soon as possible, as your employer's insurance company will likely be more skeptical of your claim the longer you wait to report it. Of course, reporting your injury sooner also means you'll start receiving benefits earlier.
File a Claim for Benefits
In addition to reporting your injury to your employer, most states also require you to file a claim with your state workers' comp agency (your employer is responsible for filing the claim in some states). The deadline to file a claim is usually about one to three years after your injury.
Review the Insurance Company's Decision
The insurance company then conducts an investigation to determine whether to approve or deny your claim. Most states require the insurance company to tell you what it decided within two to four weeks. If your claim is approved, you'll start receiving benefits. If your claim is denied, you have the right to appeal.
Appeal a Workers' Comp Denial
Appealing a workers' comp decision can be complicated and time-consuming. It often involves several proceedings, a settlement conference or mediation, and an Independent Medical Examination. For these reasons, you should seriously consider hiring an experienced workers' comp attorney to represent you during your appeal.
How Workers' Comp Works
Independent Medical Examinations
If your employer's insurance company disagrees with a decision by your treating doctor about your medical treatment, the insurer usually has the right to demand that you be evaluated by a doctor of its choice. This is called an Independent Medical Examination (IME), but because the insurance company selects and pays for the doctor, IMEs may not be truly independent or objective.
Some states have addressed this by requiring what they call impartial medical examinations. In these states, doctors are randomly selected from a list of qualified specialists that the workers' comp agency has determined to be impartial. And there are some states where, if you disagree with your treating doctor's opinions, you can request an IME and select the IME doctor yourself.
During the IME, you'll be required to provide detailed background related to your injury, including an explanation of how it occurred, what your symptoms are, your treatment so far, and your relevant medical history. The doctor will probably also conduct a physical examination.
After the IME, the doctor will prepare a report containing his or her conclusions. This report can have a significant impact on the outcome of your case, as workers' comp judges often view IME doctors as experts and put a lot of stock in their opinions. However, you can dispute the report if it contains factual inaccuracies. A workers' comp attorney can be very helpful if issues arise in connection with the IME exam and report.
Mediation or Settlement Conference
Before you have a hearing on your claim, a workers' comp judge will often require you to participate in a settlement conference or mediation. At the mediation, a neutral third party will help you and the insurer attempt to resolve your claim informally.
The mediator will hear your arguments, and will discuss the claim with you and the insurance company both together and separately. If you can't reach an agreement, your case will be set for a formal hearing.
Workers' Comp Hearing
The workers' comp hearing is your opportunity to make your case to a judge. This will involve arguments by the lawyers, testimony by witnesses (including your own testimony), and presentation of evidence such as medical records, documents showing lost wages, and doctors' reports.
When you testify, your own lawyer will ask you questions, and then the insurance company's lawyer will ask you additional questions (called "cross-examination"). Most workers' comp hearings last a few hours, although they can continue for several days if your case is complex.
About 30 to 60 days after the hearing, the judge will make a decision in writing. You have the right to appeal that decision if the judge rules against you. An experienced workers' comp attorney can help with that appeal as well.
Hire a Workers' Comp Lawyer
An experienced lawyer can prepare a legal analysis of your claim, negotiate for you at your settlement conference, and represent you at your hearings.
Hiring a workers' comp lawyer won't cost you anything out of pocket. In most states, workers' comp attorneys charge a percentage of your benefits if you win your case, and nothing if you lose.