HOW DO I FILE A CLAIM? - Related Questions

What is the filing process?

The first step in the filing process for a typical workers' compensation claim is to file an employee claim form report of the incident. This should be filed as soon as the injury occurs. Your employer will then file the report with the private insurer that provides coverage for your company. Depending on your state of residence or employment, the form varies. Each state has a specific form and process. Furthermore, some state workers' compensation boards require that the form be filed directly with the board. Either the review board or the insurance company will review your initial claim. You will typically be asked to undergo an independent medical examination (IME) with a doctor that is chosen by the insurance company. The results of this exam are given to the insurance company, and are used to determine its compensation offer.

Should the claim be approved, your benefit payments will begin shortly after you receive notice of approval. However, initial claims often require further supporting evidence (such as a second medical examination from another doctor), or are denied. Insurance companies sometimes refer to a denied claim as a "controverted" claim. Should your initial claim result in this status, the next step is appeal. You are also able to appeal the compensation decision if you are unhappy with the results and do not feel you are being adequately compensated for the injury, or not receiving authorization to visit needed medical specialists. The appeal process can be frustrating and time consuming. Each state has a specific process of appeal, yet regardless of the state, the process is best handled with the assistance of a legal professional. Insurance companies have experts that handle disputed claims and they have considerable experience in the workers' compensation process. You are entitled to represent yourself, however, as with any legal proceeding, a legal professional will ensure that you receive the maximum amount of benefit for your disability.

How long will it take?

The amount of time that it takes to receive a scheduled payment after you file your initial claim varies widely from state to state. Should your initial claim be approved, it can take as little as 30 days to receive your first payment. However, this is not a typical scenario. For a federal worker filing a workers' compensation claim with the federal government's OWCP, the typical time is 3-6 months. That means, should the initial claim be approved it can take as little as 3 months. However, because most claims require a second round of medical examinations, the federal worker can expect a wait time of 6 months or more between the initial claim and receipt of first payment.

Because many claims, regardless of the state in which they are filed, require a second medical examination, the time before receipt of first scheduled payment can cause a financial hardship on the injured worker. For this reason, it is highly recommended that an injured worker obtain professional legal assistance when applying for workers' compensation.

What are the benefits of hiring an attorney?

By law, you have the right to represent your own interests when filing a workers' compensation claim. You are not required to hire an attorney. However, because the process of filing a workers' compensation claim can be complex, many injured workers hire a legal professional or an attorney to advocate on their behalf. This is to ensure that they receive the maximum amount of compensation for which they are eligible. If you are an injured worker that has always worked hard for his or her employer, it may be difficult to accept that you can no longer work in the same capacity as you once did. Moreover, you may also have personal issues with receiving the assistance you need to sustain yourself. An attorney or legal professional can help to ease the burden and stress of dealing with the complex and bureaucratic process of receiving compensation. Furthermore, dealing with the complexities of the workers' compensation process as well as the emotional and physical strain of a debilitating injury is overwhelming for most people. An attorney advocates for you and eases many of the legal and emotional hassles so you can focus on recovery or rehabilitation.

Insurance companies and state agencies are focused on giving you the smallest amount possible for your injury. They are professionals and deal with this system on a daily basis. Their experience and knowledge of the system is a tremendous asset in contested or difficult claims.

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