When to File a Workers Comp Claim (& When Not to!)

In 2012 alone, three million nonfatal workplace accidents occurred in the United States. That means, for every 100 full-time employees, 3.5 got injured. If this has happened to you, how do you know when you should file a workers’ comp claim?

From lost wages to permanent disability, workers’ compensation can provide you with financial compensation. But you need to know your rights and how the process works. Read on to learn more about when to file a workers’ comp insurance claim.

Workers’ Comp 101

If you’ve ever been the victim of a workplace illness or injury, you may be entitled to benefits that you don’t even know you have. Many employees feel shocked to learn that worker’s comp may cover everything from medical care to lost wages.

In order to receive these benefits, however, you must file a claim. But as an employee, you may feel hesitant to file a legal complaint against your employer. After all, how do you know if your injury even warrants filing a claim?

If you need to seek medical treatment for an injury sustained in the work environment, then you should file a worker’s comp claim. Of course, knowing when to see a doctor or go to urgent care or the ER can feel subjective.

But remember that time is of the essence. The first step in just about every one of the 50 states remains letting your boss know about your illness or injury. And the sooner you do it, the better.

When to File?

You need to meet certain basic criteria before you file workers’ comp. If the three following statements prove true, then start filling out paperwork:

  • You were hurt or developed an illness as the direct result of a job-related duty.
  • Your employer carries worker’s compensation insurance.
  • You are an employee (not an independent contractor or freelancer) of the business where your injury or illness occurred.

As you can see, many of the injuries you’re likely to sustain on the job should get covered by insurance. These include injuries or illnesses resulting from:

  • Chemicals in the workplace
  • Work activities
  • Job site accidents
  • Work-related trauma injuries

Depending on your state of residence, you may have a limited number of days to report the incident that caused your injury or illness. That also means a narrow window of time to submit paperwork to get the ball rolling on your claim.

When Not to File a Claim

But what if you remain unsure about whether or not your injury or illness will get covered? While each state varies, workers’ comp won’t generally cover medical conditions resulting from:

  • Psychiatric injuries
  • Stress
  • Self-inflicted injuries
  • Injuries that happen on the way to or from work
  • Injuries caused by horseplay or fighting on the job
  • Injuries that happen while under the influence of drugs or alcohol
  • Injuries resulting from a violation of company policies
  • Injuries caused while committing a crime

That said, your case should get evaluated in the context of your state’s regulations. Again, your best tactic remains to find good legal representation. That way, you’ll better understand your rights and how they apply to your unique situation.

Just make sure that you proceed in a timely manner. Procrastination is not your friend when it comes to claims for injuries sustained in the workplace.

Why Time Matters

The longer you wait to report an illness or injury to your workplace, the more skeptical they’ll feel about how you sustained your injury. The same goes for their insurance company. Ideally, you should report a health issue when it happens.

What’s more, the faster you file your claim, the faster you’ll start seeing benefits. That requires going to the doctor the moment you notice a problem. It does you no good to grin and bear it when it comes to a potential work-related health problem.

Once you’ve reported your injury or illness, your employer must provide you with the necessary paperwork to start your claim. Your employer should submit this paperwork to your state workers’ compensation agency as well as their insurance.

Differences from State to State

Unfortunately, the process of applying for workers’ comp varies by state, so you should seek legal representation to help you navigate the applicable laws. For some states, your claim begins the moment you fill out paperwork.

For other states, you may need to file separate paperwork with your state’s workers’ comp agency. Note that deadlines associated with this paperwork also differ from state to state.

Finally, the law gets complicated when it comes to cumulative injuries such as repetitive motion injuries. After all, if it took years for a condition to develop, when does the clock start ticking on filing a claim?

While there are no hard and fast rules on this, you need to act as soon as you realize one of two things. First, your injury is work-related. Or, second, you must take time off as the result of said injury or illness.

When Employers Refuse to Cooperate

Although rare, you may find yourself in a situation where your employer refuses to cooperate with you. They may ignore your complaints or even refuse to provide you with the necessary paperwork to complete your claim. What should you do?

In such a case, turn to your state workers’ compensation agency for assistance. A call to this agency usually takes care of the situation.

Remember that if you’re a federal employee, you’ll need to go through an entirely different process for your claim. The forms that you’ll need to fill out as well as a comprehensive list of instructions to follow to make your claim can be found here.

Time for a Workers’ Comp Claim?

When it comes to staying empowered in the workplace, start by understanding your rights, especially when it comes to workplace injuries and illness. You should also do everything that you can to stay safe and prevent injuries on the job site.

That said, work-related injuries and illnesses happen more often than you might think. If you’re considering a workers’ comp claim, it’s time to get help. Contact us today to learn more about your rights as an employee.

Spread the word. Share this post!