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Filing A Claim For Workers' Compensation

HandelontheLaw.com Staff Writer

Tuesday, December 10, 2013



Filing  A Claim For Workers' Compensation
Workers Compensation

Workers’ Compensation (sometimes called “Workman’s Comp”) is insurance that provides guaranteed payment of medical bills and compensation to employees for work-related injuries or illnesses. People who sustain work-related injuries or illness need money to pay their medical expenses and living expenses; however, if all those people sued their employers, the burden on court systems would be crushing, employees would have different degrees of success in proving their cases, and the amounts of money gained in those suits could vary wildly from zero to who-knows-what. These are the basic reasons for workers’ compensation systems and those systems have been reworked and refined over decades until their processes are relatively smooth.

Does this sound too good to be true? Well, in a sense it is too good to be true: not every worker is covered. First, your employer must have workers’ compensation insurance or be legally required to carry it. Depending on your state’s or territory’s system, the type of business, type of work you’re performing and number of employees in the business can all determine whether or not you are covered by workers’ compensation. Some employers who are not legally required to have the insurance have it anyway; other employers who are legally required to have the insurance don’t have it anyway. If your employer does not have the insurance, there may be a state/territorial fund that will cover you anyway: states and territories are used to compensating for people and organizations that violate the law and workers’ compensation is no exception. Secondly, in order for your injury/illness to be covered, you must be an employee. Independent contractors and volunteers are not normally deemed employees. Of course, there are exceptions and your state/territory law will determine whether you are an “employee” for purposes of workers’ compensation. Third, your injury/illness must be work-related. State laws vary but generally, if you are performing some act that is supposed to benefit your employer and you become injured/ill because of it, then your injury/illness is work-related. Location is not the key: notice that the injury/illness does not need to be at the workplace in order to be work-related; notice also that an injury/illness occurring at the workplace isn’t necessarily work-related. The key is whether you are acting for your employer’s benefit. If your injury/illness is not work-related, then your recourse is somewhere else (possibly court); not within the workers’ compensation system. Fourth, some injuries/illnesses are not covered. If the employee’s injury/illness was caused by the employee’s use of alcohol or illegal use of drugs, then the injury/illness is not covered. Injuries or illnesses while the employee was violating company policy or committing a crime are not covered, either. Finally, injuries/illnesses that are self-inflicted are not covered by workers’ compensation.

Workers’ Compensation is not a single, uniform system. Federal workers are covered by a federal system while everybody else is at least theoretically covered by his/her own state’s or territory’s system. A federal worker injured or made ill on the job is required to follow steps well-guided steps found here: http://www.dol.gov/dol/topic/workcomp/. A non-federal employee with a work-related injury/illness must look to his/her state’s or territory’s workers’ compensation system. The U. S. Department of Labor provides handy links to each state’s system here: http://www.dol.gov/owcp/dfec/regs/compliance/wc.htm#NY . By clicking that link, you will find further links for each state or territory and clicking through those links will take you to your state’s/territory’s directions and forms.



To give you a basic idea of how the system would work for a non-federal employee, I’ll use California’s workers’ compensation system. This link http://www.dol.gov/owcp/dfec/regs/compliance/wc.htm#NY leads to a clickable map of the United States and a listing of each separate state’s office handling its workers’ compensation claims. California’s office is the Department of Industrial Relations, Division of Workers’ Compensation. By clicking on California’s name/link, I was led to this site: http://www.dir.ca.gov/dwc/dwc_home_page.htm. California’s web site “bends over backwards” giving information, directions, forms, phone numbers, addresses, etc., all designed to help you with your claim.

According to California, if you have a work-related injury/illness, your basic benefits under workers’ compensation may be: medical care; temporary disability payments; permanent disability benefits; supplemental job displacement benefits; death benefits to your spouse/children/other dependents if you die from the injury/illness. The claims process is logical and pretty straightforward. First, report it to your supervisor immediately or as soon as you learn/believe the injury/illness is work-related (and if you do not report within 30 days of the injury/illness or discovering it is work-related, your workers’ compensation claim could be denied). Secondly, get emergency treatment if necessary (possibly by a medical provider designated by your employer). Third, tell the medical provider that the injury/illness is work-related; fill out a claim form, which your employer is supposed to give/mail to you within 1 working day after the employer learns of your injury/illness and which you can also find here: http://www.dir.ca.gov/dwc/DWCForm1.pdf. Fourth, give the completed form to your employer as soon as possible, which is when the claims administrator begins to process your claim. California is an old pro in dealing with employers who might stall or be unreasonably difficult about your claim; therefore: if your employer does not accept/deny your claim within 90 days, there is a presumption that the injury/illness is work-related; while your claim is being handled by the claims administrator, you will receive up to $10,000 in treatment; if your disability payments are late, they will be increased; there are state-mandated methods for resolving disagreements between you and the claims administrator about whether the injury/illness is work-related, the medical treatment you obtain, and/or whether you are entitled to permanent disability benefits.


DO’S AND DON’TS

DO determine whether your employer carries or is required to carry workers’ compensation insurance.

DO determine whether you are an “employee” for purposes of the insurance.

DO determine whether your injury/illness is “work-related,” generally meaning that it was incurred while you were acting for your employer’s benefit.

DON’T file for workers’ compensation if your injury/illness was caused: by your use of alcohol or illegal use of drugs; OR while you were violating company policy or committing a crime; OR if your injuries were self-inflicted.

If you are a federal worker, DO use the following link to access directions and forms for your workers’ compensation claim: http://www.dol.gov/dol/topic/workcomp/.

If you are a non-federal worker, DO use the following link to access your state’s/territories’ web site for workers’ compensation: http://www.dol.gov/owcp/dfec/regs/compliance/wc.htm#NY.

IF YOU ARE IN CALFORNIA

DO use this link to access the State’s site: http://www.dir.ca.gov/dwc/dwc_home_page.htm.

DO report your work-related injury/illness to your supervisor immediately or as soon as you learn/believe the injury/illness is work-related.

DO tell your supervisor no more than 30 days after you are injured or you discover that your injury/illness is work-related.

DO get emergency treatment if necessary.

If your employer designates a medical provider, DO use that medical provider.

DO tell your medical provider that your injury/illness is work-related.

DO fill out a claim form that you can access here: http://www.dir.ca.gov/dwc/DWCForm1.pdf.

DO give the completed form to your employer.


By Kathy Catanzarite


[Note from HandelontheLaw.com: This article is to be used as an educational guide only and should not be interpreted as a legal consultation. Readers of this article are advised to seek an attorney if a legal consultation is needed. Laws may vary by state and are subject to change, thus the accuracy of this information cannot be guaranteed. Readers act on this information solely at their own risk. Neither HandelontheLaw.com, or any of its affiliates, shall have any liability stemming from this article.]


Source: Kathy Catanzarite - Handelonthelaw.com Staff Writer

Note from HandelontheLaw.com: This article is to be used as an educational guide only and should not be interpreted as a legal consultation. Readers of this article are advised to seek an attorney if a legal consultation is needed. Laws may vary by state and are subject to change, thus the accuracy of this information can not be guaranteed. Readers act on this information solely at their own risk. Neither the author, handelonthelaw.com, or any of its affiliates shall have any liability stemming from this article.





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