What is the Workers' Compensation Claims Process?

They say there is nothing like perspective, and if you’ve sustained an on-the-job injury, you will probably relearn the value of this truism.

While I can speak only about my experience – a fractured wrist, resulting from a fall – I learned early on that many injured employees feel rattled and apprehensive, unsure of what to expect from one day to the next as the claims process unfolds. These emotions underscore the wisdom in securing the services of the most experienced workers’ comp lawyer in Orlando; wise, reassuring counsel is exactly what many injured workers – myself included – need most to guide them through the claims process.

Now that I have that all-important perspective, I clearly see that filing a workers’ compensation claim is exactly that: a process. You must keep organized records, you cannot skip a step and you certainly cannot rush the process along. It unfolds at its own pace. And with perspective, the process seems both sensible and logical.

Don’t Confuse “No Fault” with “Sure Thing”

First, a caveat on workers’ compensation claims in general. Many injured employees seem to understand that workers’ compensation is a form of insurance that employers secure to literally compensate employees who become injured or contract an illness or disease on the job.

Petitioners do not have to prove fault to file a claim. The fault is what you might call a “non-issue.” Petitioners must prove only that their injury, illness, or disease occurred in the course of performing a job-related task. They do not have to prove that the employer or co-workers were somehow complicit or did something to cause the injury, illness, or disease. What’s more, even if the petitioner’s negligence contributed to the injury, the petitioner is still entitled to the payment of workers’ comp benefits.

From this perspective, a workers’ compensation claim looks like a sure thing. But the payment of the benefits is not automatic – another reason why the claims process should be followed to the letter. A thorough workers’ comp attorney will insist on it.

Follow the Process One Step at a Time

  • Seek medical treatment. I nearly bypassed this step because I thought I was dealing with a mere sprain that would improve with regular ice pack treatments. When it didn’t and I saw a physician of my choosing, he informed me that this is a crucial first step in the claims process. His report formed the basis of the “official record” that outlined the nature of my injury, the prognosis, and the recommended treatment plan.
  • Inform your employer of the injury. My work-related injury occurred on a Friday; I notified my company’s human resources department on the following Monday. Then came a deluge of paperwork, asking for the basic information you would expect: when and how my injury occurred, the specific nature of my injury and the medical treatment I had received thus far.
  • See a physician designated by the company. I had sustained a complex break and wasn’t entirely confident about my physician’s treatment plan. So I have actually gratified that my employer said I also would have to make an appointment with a company-designated physician. I viewed this step as a sort of “ the second opinion,” though I wasn’t sure how I would reconcile competing treatment plans.
  • Ensure that the claim is officially opened, usually after the proper paperwork has been received from the employer and the company’s designated physician. The good news: the insurer faces a time limit – usually within 30 days – to issue a “determination of compensability.”
  • Seek legal help from a top workers’ comp lawyer in Orlando. I learned that there is a “right” time in the claims process to seek legal help. I understand that some people do so before they notify their employer of their injury while other people consult a lawyer only if their claim is denied. Since I had to wait for the insurer to evaluate my claim anyway, I began looking for the most competent workers’ comp attorney. I was motivated partially by fear, though not that the insurer would deny my claim. I knew that employers are required by law to provide workers’ compensation – and they face stiff fines and criminal charges if they withhold it. So while I wasn’t worried about my claim being rejected, I was worried about the treatment plan, which would directly affect the compensation I would receive. I thought another pair of eyes on this process – expert, legal eyes – would be in my best interest.
  • Wait for the final word from human resources. Fortunately, my claim was accepted, and my medical and physical therapy expenses were covered. In fact, my compensation package was higher than what I probably would have received if I had not seen the company-designated physician, who recommended a more thorough and rigorous physical therapy plan than the original physician.
  • Pursue a hearing if your claim is denied. This is the juncture that many people reach out to a workers’ comp attorney.

I will never regret hiring a lawyer when I did. After going through the workers’ compensation process, I believe it’s true that there is nothing like perspective. Now that I have it, I see that hiring a savvy attorney was one of the best steps I took.

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