How to Apply for Workers’ Compensation Payments

Employees that are injured on the job may be eligible to apply for workers’ compensation. Per employment law, employers are typically obligated to provide workers’ comp and assist covered staff in the process of applying. This is true for most states, but not all. Laws surrounding workers’ comp are regulated at the state level and thus may be subject to different application time-tables, qualifying factors, and benefits. This makes it important to consult with a workers’ compensation attorney in your state, who can help navigate the specific local laws and processes.

The following article details the steps you should take to put forth a favorable claim when filing for workers’ comp. Cooperation with employers, the quick gathering and submission of documents, and a well-thought-out claim are among the most important considerations. A successful claim may entitle you to benefits such as medical care, compensation for wages lost during recovery, and even permanent disability benefits. 

Keep in mind that workers’ comp typically won’t cover: 

• Stress or other psychiatric injuries;
• Self-inflicted injuries, such as from horseplay or fighting;
• Injuries that occur while intoxicated or using illegal drugs;
• Injuries that occur while commuting to or from work.

Seek Medical Attention

The first step you should take after sustaining an injury at work is to seek medical attention. For a serious or urgent injury, go directly to the emergency room or urgent care. Other injuries should also be dealt with quickly. This step is important for not only addressing the injuries you have sustained, but also for receiving compensation for them. A doctor can provide immediate medical attention, give a thorough evaluation, and potentially even direct you to apply for workers’ comp. 

Remember to be careful about what you say to your workers’ compensation doctor. Like any other insurance provider, these providers will look for reasons to deny or reduce claims. 

Below are a few words of wisdom to keep in mind when speaking to your workers’ compensation doctor: 

• Do not exaggerate your symptoms;
• Do not lie about your symptoms;
• Do not forget to share past injuries;
• Do not leave out any details pertaining to the accident;
• Do not skip appointments.

Report the Injury

Soon after seeking medical attention, you should report the injury to your employer and then to insurance providers. This is a time-sensitive matter — filing a request for workers’ comp too late could result in the denial of a claim. Both the employer and the employee need to work quickly and cohesively. 

The employer is responsible for providing the appropriate paperwork and guidance, filing the claim with the insurer, and complying with state laws. The employee is responsible for notifying the employer of the injury (i.e. type, severity, when, and how it occurred) and filing a formal claim. These will be explained in more depth further below. 

Workers’ comp is regulated by the state meaning that different policies and protocols are required depending on where you live. Make sure to research when a claim needs to be received in your state. 

Complete Paperwork

Once you have reported the injury, it is time for the paperwork. Your employer must provide a claim form so that you may become eligible to receive workers’ comp benefits. In some states, you are also required to file an official workers’ comp claim with the state workers’ compensation agency. Deadlines for this step vary by state. Contact your state’s workers’ compensation officials for more information. 

Federal employees should refer to the Division of Federal Employees’ Compensation as they are subject to entirely different policies and procedures than other workers.  

Information You Need to File a Workers’ Comp Claim

Below is a general list of the information needed to file a workers’ comp claim:

• Name;
• Date of birth;
• Social Security number;
• Hire date;
• Wage info;
• Date of the incident;
• Details of the incident;
• Type of injury/body part(s) injured;
• Past injuries;
• Health conditions; 
• Your current treating doctor;
• When you first went for treatment;
• How long you may be out, if known;
• Benefits you are seeking.

Other information you may need or want to include in your claim:

• Medical reports;
• Unpaid medical bills;
• Witness statements;
• Witness names;
• Any reports with details regarding how the accident occurred.

Employer Claim Submission

After all the paperwork is completed, your employer must submit the claim to the workers’ comp insurance carrier. Employers may also need to submit information to the state workers’ compensation board. This typically applies to any employee who was injured on the job, whether they are seeking benefits or not.

Your doctor must send in a medical report as well. 

Approval or Denial of the Claim

The workers’ comp insurance provider will decide whether you are approved or denied. Different steps follow depending on the results of your claim. If the claim is approved, you may start accepting payments, benefits, and potentially lost wages, or you may negotiate for a lump-sum settlement. If the claim is denied, you may ask the insurance provider to look back over the decision or file an appeal. Using a lawyer in your area can be beneficial whether your claim is approved or denied. 

Returning to Work

After healing from an injury, you may be ready to return to work. A successful workers’ comp claim may continue benefits even following your return. Employers may need to make changes to accommodate your return to work, such as providing new training. The ability to return to work largely depends on whether you’ve received short-term or long-term disability coverage. Employees that have been completely disabled as the result of an on-the-job injury or illness can be given a pension, and cannot return to work. 

Workers’ comp payments are non-taxable, but any income gained upon returning to work even if only for light tasks are taxable.  

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